Jármay Katalin, Lonovics János, Schaff Zsuzsa
Szegedi Tudományegyetem, Szent-Györgyi Albert Orvos- és Gyógyszerésztudományi Centrum, Egészségügyi Fóiskolai Kar.
Orv Hetil. 2003 Jul 6;144(27):1325-30.
Chronic hepatitis C is a progressive liver disease. It may lead to cirrhosis within 15-20 years, on the grounds of which hepatocellular carcinoma may develop in around 4% of the cases. The entity can thus be regarded a premalignant condition. Based on the above, early diagnosis is of great importance, as is prompt treatment.
Analysing the 106 biopsy specimens most frequently mild degree of inflammation was found. The majority of cases were in stage 1 (41.5%), however 8.69% were already in stage 4. Lymphoid aggregates/follicles and bile duct lesion were in correlation with the activity of the disease. A considerable decrease in the ALT level and in the histologic activity was induced by the 12 months interferon-alpha treatment. A positive correlation was found for the expression of the nuclear proteins used as proliferation markers in minimal and mild activity cases, while in moderate chronic hepatitis C a remarkable decrease was manifest in respect to cyclin-A activity. After 12 months IFN-alpha treatment the proliferating cell nuclear antigen activity increased, with a decrease in cyclin-A positivity.
Chronic hepatitis C cases with mild activity may also belong to stage 4, the need for liver biopsies should therefore be considered even besides the presence of near normal biochemical parameters in certain cases. The positive correlations between lymphoid follicles/aggregates, bile duct lesions and chronic hepatitis C activity refers to the fact that the above noted histologic differences may be evaluated as prognostic factors. The 12 months interferon-alfa treatment has a moderating effect on cell proliferation, as shown by the lowered cyclin-A expression and does have an effect on particular components playing role in the early phase of fibrogenesis.
慢性丙型肝炎是一种进行性肝病。它可能在15至20年内发展为肝硬化，在此基础上，约4%的病例可能会发展为肝细胞癌。因此，该疾病可被视为一种癌前病变。基于上述情况，早期诊断和及时治疗都非常重要。
对106份活检标本进行分析，发现炎症程度大多为轻度。大多数病例处于1期（41.5%），然而8.69%已处于4期。淋巴样聚集/滤泡和胆管病变与疾病活动相关。12个月的α干扰素治疗导致谷丙转氨酶水平和组织学活性显著下降。在轻度和极轻度活动病例中，用作增殖标志物的核蛋白表达呈正相关，而在中度慢性丙型肝炎中，细胞周期蛋白A活性显著下降。12个月的α干扰素治疗后，增殖细胞核抗原活性增加，细胞周期蛋白A阳性率下降。
轻度活动的慢性丙型肝炎病例也可能属于4期，因此在某些病例中，即使生化参数接近正常，也应考虑进行肝活检。淋巴滤泡/聚集、胆管病变与慢性丙型肝炎活动之间的正相关表明，上述组织学差异可作为预后因素进行评估。12个月的α干扰素治疗对细胞增殖有抑制作用，表现为细胞周期蛋白A表达降低，并且对在纤维化早期起作用的特定成分确实有影响。
