Ortiz Vicente, Berenguer Marina, Rayón José M, Carrasco Domingo, Berenguer Joaquin
HepatoGastroenterology Service, Hospital Universitari La Fe, Valencia, Spain.
Am J Gastroenterol. 2002 Sep;97(9):2408-14. doi: 10.1111/j.1572-0241.2002.05995.x.
Hepatitis C virus (HCV) disease progression is variable. Identification of factors predictive of rapid progression is an important goal for improving patient management. The aim of this study was to evaluate the predictive role of several variables, including some that are etiologically related to the nonalcoholic steatohepatitis (NASH) syndrome such us obesity, in fibrosis progression in both patients with elevated and normal transaminase levels.
A total of 114 chronic HCV-infected (HCV-RNA positive) patients were recruited prospectively between 2000 and 2001. All patients had at least one liver biopsy. The annual change in fibrosis stage (fibrosis progression rate) was assessed from the time of presumed infection (fibrosis = 0) among those who had only one biopsy (n = 97) or between two biopsies if these were available (n = 17). Based on published data, we arbitrarily defined a patient as a rapid progressor when the fibrosis progression rate was > 0.2 U/yr. Potential predictors of rapid progression were: age at infection and biopsy, sex, significant alcohol intake (> 50 g/day), risk factor of HCV acquisition (based on answers to a questionnaire), obesity (based on body mass index [BMI]), autoantibodies, iron overload (ferritin, transferrin saturation), diabetes, hyperlipidemia, anti-HBcore IgG, genotype, and viral load.
The median fibrosis progression rate was 0.05 U/yr (range 0-1.58 yr). In all, 22 patients (19%) were rapid progressors. Variables associated with progression by multivariate analysis included: advanced age at infection (p = 0.0001), BMI > or = 25 (p = 0.01), and ALT > 1.5 times upper limit of normal (p = 0.01). Among patients with ALT > 1.5 times upper limit of normal, these variables were advanced age at infection, BMI > or = 25, diabetes and transferrin saturation > 45. Among those with normal ALT levels, only BMI > or = 30 was predictive of progression.
Obesity, advanced age at infection, and elevated ALT levels predict rapid disease progression, suggesting that measures aimed at weight reduction may play a significant role in hepatitis C management. The natural history of hepatitis C is independent of the presence of autoimmunity markers.
丙型肝炎病毒（HCV）疾病进展具有变异性。识别预测快速进展的因素是改善患者管理的重要目标。本研究的目的是评估几个变量的预测作用，包括一些与非酒精性脂肪性肝炎（NASH）综合征病因相关的变量，如肥胖，对转氨酶水平升高和正常的患者纤维化进展的影响。
2000年至2001年期间前瞻性招募了114例慢性HCV感染（HCV-RNA阳性）患者。所有患者至少进行了一次肝活检。对于仅进行一次活检的患者（n = 97），从假定感染时（纤维化= 0）评估纤维化阶段的年度变化（纤维化进展率）；如果有两次活检结果，则在两次活检之间评估（n = 17）。根据已发表的数据，当纤维化进展率> 0.2 U/年时，我们将患者任意定义为快速进展者。快速进展的潜在预测因素包括：感染时和活检时的年龄、性别、大量饮酒（> 50克/天）、HCV感染的危险因素（根据问卷回答）、肥胖（根据体重指数[BMI]）、自身抗体、铁过载（铁蛋白、转铁蛋白饱和度）、糖尿病、高脂血症、抗-HBcore IgG、基因型和病毒载量。
纤维化进展率的中位数为0.05 U/年（范围0 - 1.58年）。共有22例患者（19%）为快速进展者。多变量分析显示与进展相关的变量包括：感染时年龄较大（p = 0.0001）、BMI≥25（p = 0.01）以及ALT>正常上限的1.5倍（p = 0.01）。在ALT>正常上限1.5倍的患者中，这些变量为感染时年龄较大、BMI≥25、糖尿病和转铁蛋白饱和度> 45。在ALT水平正常的患者中，只有BMI≥30可预测疾病进展。
肥胖、感染时年龄较大和ALT水平升高可预测疾病快速进展，这表明旨在减轻体重的措施可能在丙型肝炎管理中发挥重要作用。丙型肝炎的自然病程与自身免疫标志物的存在无关。
