Okanoue Takeshi, Minami Masahito, Makiyama Akiko, Sumida Yoshio, Yasui Kohichiroh, Itoh Yoshito
Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Clin Gastroenterol Hepatol. 2005 Oct;3(10 Suppl 2):S89-91. doi: 10.1016/s1542-3565(05)00701-9.
A long-term follow-up study was performed to identify the natural course of chronic HCV carriers with persistently normal serum ALT level (PNAL; < or =30 U/L) and to clarify the effect of interferon therapy on the inhibition of the development of hepatocellular carcinoma (HCC) in chronic hepatitis C patients with elevated ALT levels. One hundred twenty-nine HCV carriers with PNAL underwent liver biopsy, 69 were followed for more than 5 years, and 35 underwent serial liver biopsies. We included 1246 chronic hepatitis C patients (stage F1: 231, F2: 638, F3: 336, F4: 41) who received interferon therapy and were followed for more than 2 years (mean, 7.7 years). Approximately 90% of HCV carriers with PNAL had normal to mild liver histology, and 30% developed symptomatic chronic hepatitis C within 5 years. The frequency of steatosis and iron loading was significantly lower in these patients than in symptomatic chronic hepatitis C patients. The progression rate of fibrosis was slower than in chronic hepatitis C patients with elevated serum ALT levels. HCC was noted in 157 chronic hepatitis C patients after interferon therapy, and the development of HCC was significantly reduced in both sustained responders and transient biochemical responders compared with nonresponders. HCC in sustained responders mainly developed in male patients older than 55 years with advanced stage liver histology at entry. Approximately 30% of HCV-infected patients with PNAL become candidates for antiviral therapy within 5 years. Interferon therapy lowers the rate of the development of HCC in both sustained responders and transient biochemical responders.
进行了一项长期随访研究，以确定血清ALT水平持续正常（PNAL；≤30 U/L）的慢性丙型肝炎病毒（HCV）携带者的自然病程，并阐明干扰素治疗对ALT水平升高的慢性丙型肝炎患者肝细胞癌（HCC）发生发展抑制作用的影响。129例PNAL的HCV携带者接受了肝活检，69例随访超过5年，35例接受了系列肝活检。我们纳入了1246例接受干扰素治疗并随访超过2年（平均7.7年）的慢性丙型肝炎患者（F1期：231例，F2期：638例，F3期：336例，F4期：41例）。约90%的PNAL的HCV携带者肝脏组织学正常至轻度异常，30%在5年内发展为有症状的慢性丙型肝炎。这些患者的脂肪变性和铁过载发生率显著低于有症状的慢性丙型肝炎患者。纤维化进展速度比血清ALT水平升高的慢性丙型肝炎患者慢。干扰素治疗后，157例慢性丙型肝炎患者发生了HCC，与无反应者相比，持续反应者和短暂生化反应者的HCC发生率均显著降低。持续反应者中的HCC主要发生在入组时肝脏组织学处于晚期的55岁以上男性患者中。约30%的PNAL的HCV感染患者在5年内成为抗病毒治疗的候选者。干扰素治疗降低了持续反应者和短暂生化反应者的HCC发生率。
