Kawamura Yusuke, Akuta Norio, Sezaki Hitomi, Hosaka Tetsuya, Someya Takashi, Kobayashi Masahiro, Suzuki Fumitaka, Suzuki Yoshiyuki, Saitoh Satoshi, Arase Yasuji, Ikeda Kenji, Kumada Hiromitsu
Department of Gastroenterology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan.
J Gastroenterol. 2005 Sep;40(9):901-6. doi: 10.1007/s00535-005-1636-6.
Phlebotomy is performed to reduce excessive iron accumulation in hepatic tissue. We studied serum alanine aminotransferase (ALT) normalization rates and 50% reduction in initial serum ALT (ALT(50%) reduction rate) in patients with hepatitis C viral (HCV) infection and investigated the factors that influenced the response to phlebotomy therapy.
We evaluated 23 consecutive patients with HCV infection who underwent phlebotomy. Phlebotomy was performed a few times per week, then a few times per month, and 200-400 ml of blood was removed at each session, depending on the clinical response. During the course of therapy, hemoglobin (Hb), serum ALT, and ferritin levels were assessed monthly.
In patients with Hb of less than 11 g/dl, the ALT(50%) reduction rate was 87.5%. In patients with a serum ferritin level of less than 10 g/dl the ALT(50%) reduction rate was 83.3%. In patients with Hb of less than 11 g/dl, the ALT normalization rate was 50%, and in those with a serum ferritin level of less than 10 g/dl, the ALT normalization rate was 41.7%. Multivariate analysis identified ALT less than 100 IU/l at the start of phlebotomy as an independent factor associated with ALT normalization. Of the 7 patients who showed no response to phlebotomy, 85.7% were obese (body mass index > or =25 kg/m(2)), and 40% showed more than 30% steatosis on liver histology. The cumulative ALT normalization rate in relation to the total volume of blood loss was 43.9% with a blood less or more than 3 l, and thus was optimal above 3 l.
Although the sample number was relatively small, the results of our study suggest that phlebotomy is effective therapy for HCV patients who are nonobese, show little or no steatosis on liver histology, and have a baseline serum ALT level of less than 100 IU/l.
进行静脉放血以减少肝组织中铁的过度蓄积。我们研究了丙型肝炎病毒（HCV）感染患者的血清丙氨酸氨基转移酶（ALT）正常化率和初始血清ALT降低50%（ALT(50%)降低率），并调查了影响静脉放血治疗反应的因素。
我们评估了23例连续接受静脉放血的HCV感染患者。每周进行几次静脉放血，然后每月进行几次，每次根据临床反应抽取200 - 400 ml血液。在治疗过程中，每月评估血红蛋白（Hb）、血清ALT和铁蛋白水平。
Hb低于11 g/dl的患者，ALT(50%)降低率为87.5%。血清铁蛋白水平低于10 g/dl的患者，ALT(50%)降低率为83.3%。Hb低于11 g/dl的患者，ALT正常化率为50%，血清铁蛋白水平低于10 g/dl的患者，ALT正常化率为41.7%。多因素分析确定静脉放血开始时ALT低于100 IU/l是与ALT正常化相关的独立因素。在7例对静脉放血无反应的患者中，85.7%为肥胖患者（体重指数≥25 kg/m²），40%的患者肝脏组织学显示脂肪变性超过30%。与总失血量相关的累积ALT正常化率在失血量少于或多于3升时为43.9%，因此在3升以上时最佳。
尽管样本数量相对较少，但我们的研究结果表明，静脉放血对于非肥胖、肝脏组织学上几乎没有或没有脂肪变性且基线血清ALT水平低于100 IU/l的HCV患者是有效的治疗方法。
