D'Souza R F C, Feakins R, Mears L, Sabin C A, Foster G R
Hepatobiliary Group, Institute of Cellular and Molecular Science, Queen Mary's School of Medicine and Dentistry, London, UK.
Aliment Pharmacol Ther. 2005 Mar 1;21(5):519-24. doi: 10.1111/j.1365-2036.2005.02382.x.
Chronic infection with the hepatitis C virus affects over 170 million individuals worldwide and 20% of patients develop cirrhosis after 20 years. Increased iron stores and hepatic iron content have been suggested to be important in fibrosis progression. The increased prevalence of diabetes mellitus has been associated with increased iron deposits in patients with chronic hepatitis C.
To assess the potential relationship between serum ferritin and hepatic iron staining and liver fibrosis in patients with chronic hepatitis C virus infection and whether these factors are increased in diabetic patients with hepatitis C virus.
This was a cross-sectional, multi-centre study involving hospitals in the north-east of London between 1992 and 2003. Chronic hepatitis C patients with a liver biopsy and data concerning age, sex, basal metabolic index, diabetes mellitus or impaired glucose tolerance, alcohol intake, serum ferritin level and ethnicity were enrolled. Each biopsy was scored for fibrosis and stained for hepatic iron.
Three hundred and thirty nine patients (200 Caucasian; 139 Asian) were enrolled. Fifty three patients had no fibrosis, 131 had mild fibrosis (stage one to two Modified Ishak), 68 moderate fibrosis (stage three to four) and 87 cirrhosis (stage five to six). 4.4% of patients had elevations in serum ferritin, whilst 11% had increased hepatic iron staining. The serum ferritin and hepatic iron staining were unrelated to the degree of fibrosis. Serum ferritin was significantly higher in patients with diabetes or impaired glucose tolerance compared to non-diabetics. No association was seen between diabetes and hepatic iron staining.
Many patients with chronic hepatitis C virus infection may have elevated serum ferritin and/or iron deposition within the liver. However, both played no significant role in the progression of hepatitis C virus related liver injury. The association between chronic hepatitis C virus infection and type II diabetes mellitus exists, however the biological mechanism of this association still remains to be elucidated.
丙型肝炎病毒慢性感染影响着全球超过1.7亿人，20%的患者在20年后会发展为肝硬化。铁储存增加和肝脏铁含量升高被认为在纤维化进展中起重要作用。糖尿病患病率的增加与慢性丙型肝炎患者铁沉积增加有关。
评估慢性丙型肝炎病毒感染患者血清铁蛋白与肝脏铁染色及肝纤维化之间的潜在关系，以及这些因素在丙型肝炎病毒感染的糖尿病患者中是否增加。
这是一项横断面、多中心研究，涉及1992年至2003年伦敦东北部的医院。纳入有肝活检且有年龄、性别、基础代谢指数、糖尿病或糖耐量受损、酒精摄入量、血清铁蛋白水平和种族等数据的慢性丙型肝炎患者。对每例活检标本进行纤维化评分并进行肝脏铁染色。
共纳入339例患者（200例白种人；139例亚洲人）。53例患者无纤维化，131例有轻度纤维化（改良Ishak分期一至二期），68例有中度纤维化（分期三至四期），87例有肝硬化（分期五至六期）。4.4%的患者血清铁蛋白升高，而11%的患者肝脏铁染色增加。血清铁蛋白和肝脏铁染色与纤维化程度无关。糖尿病或糖耐量受损患者的血清铁蛋白显著高于非糖尿病患者。未发现糖尿病与肝脏铁染色之间存在关联。
许多慢性丙型肝炎病毒感染患者可能血清铁蛋白升高和/或肝脏内有铁沉积。然而，两者在丙型肝炎病毒相关肝损伤的进展中均未起显著作用。慢性丙型肝炎病毒感染与II型糖尿病之间存在关联，然而这种关联的生物学机制仍有待阐明。
