Fartoux Laetitia, Chazouillères Olivier, Wendum Dominique, Poupon Raoul, Serfaty Lawrence
Service d'Hépatologie, Hôpital Saint-Antoine, Paris, France.
Hepatology. 2005 Jan;41(1):82-7. doi: 10.1002/hep.20519.
In patients with mild hepatitis C, the usefulness of antiviral therapy is subject of debate, as a low risk for progression of fibrosis is assumed. Several studies have shown that steatosis is a strong and independent predictor of the severity as well as the progression of fibrosis in chronic hepatitis C. Therefore, this study assessed the impact of steatosis on the progression of fibrosis between paired liver biopsies in untreated patients with mild hepatitis on index biopsy. One hundred thirty-five untreated patients (mean age, 38 years; M/F sex ratio, 1.43) with one known risk factor of infection (68 transfusions, 67 injecting drug use) had 2 liver biopsies after a median interval of 61 months (18-158). All had METAVIR score of A1F1 or lower at first liver biopsy. Unequivocal progression of fibrosis was considered if patients had a fibrosis score of 3 or 4 at the second liver biopsy. The probability of progression of fibrosis was estimated by using the Kaplan-Meier method. During follow-up, progression of fibrosis occurred in 21 patients (16%) after a median delay of 65 months. Cumulative probabilities of the progression of fibrosis at 4 and 6 years were 5.2% and 19.8%, respectively. In multivariate analysis, steatosis was the only independent factor predictive of progression of fibrosis (RR, 4.8; CI, 1.3-18.3). Probability of progression of fibrosis was significantly related to the percentage of hepatocytes with steatosis. In conclusion, steatosis is a major determinant of the progression of fibrosis in mild hepatitis C, regardless of the genotype. Our results argue for antiviral treatment in the subgroup of patients with mild hepatitis and steatosis.
在轻度丙型肝炎患者中，抗病毒治疗的有效性存在争议，因为假定纤维化进展风险较低。多项研究表明，脂肪变性是慢性丙型肝炎纤维化严重程度及进展的一个强有力的独立预测因素。因此，本研究评估了脂肪变性对轻度丙型肝炎未治疗患者在索引活检时配对肝活检之间纤维化进展的影响。135例未治疗患者（平均年龄38岁；男女比例1.43），有一个已知感染风险因素（68例输血，67例注射吸毒），在中位间隔61个月（18 - 158个月）后进行了2次肝活检。所有患者首次肝活检时METAVIR评分均为A1F1或更低。如果患者第二次肝活检时纤维化评分为3或4，则认为纤维化有明确进展。采用Kaplan-Meier法估计纤维化进展的概率。随访期间，21例患者（16%）出现纤维化进展，中位延迟时间为65个月。4年和6年时纤维化进展的累积概率分别为5.2%和19.8%。多变量分析中，脂肪变性是预测纤维化进展的唯一独立因素（相对风险，4.8；可信区间，1.3 - 18.3）。纤维化进展概率与脂肪变性肝细胞百分比显著相关。总之，无论基因型如何，脂肪变性是轻度丙型肝炎纤维化进展的主要决定因素。我们的结果支持对轻度肝炎合并脂肪变性的患者亚组进行抗病毒治疗。
