Boccato S, Pistis R, Noventa F, Guido M, Benvegnù L, Alberti A
Department of Clinical and Experimental Medicine, University of Padova, Padova, Italy.
J Viral Hepat. 2006 May;13(5):297-302. doi: 10.1111/j.1365-2893.2005.00683.x.
The natural history of chronic hepatitis C presenting with no/minimal liver fibrosis is uncertain with controversies on risk of progression and need for antiviral treatment. We studied rates and determinants of fibrosis progression in initially mild chronic hepatitis C. One hundred and six patients (mean age 41.65 +/- 12.83 years) with chronic hepatitis C virus infection and no/minimal fibrosis in the initial liver biopsy (F0/F1 by METAVIR score) were followed prospectively while untreated with repeated biopsy after 5 or more years (mean interval 7.8 +/- 1.51 years). Patients showing fibrosis progression were compared with nonprogressors for baseline and follow-up parameters. Sixty-four patients (60.4%) showed fibrosis progression including 13 of 27 (49%) with F0 and 51 of 79 (65%) with F1. Progression to F3 or cirrhosis was seen in 36% of those with F1 initially. Fibrosis progression (DeltaF/year) was associated with age (P < 0.0001), baseline and follow-up alanine aminotransferase (ALT) (P = 0.005), histological activity (P = 0.004) and steatosis (P = 0.002) in the initial biopsy and use of alcohol (P = 0.008). Thus liver fibrosis progression occurs in two-thirds of patients with initially mild chronic hepatitis C within 5-10 years and advanced fibrosis/cirrhosis develops in one-third of those with F1 initially. Fibrosis is facilitated by older age and alcohol and associated with inflammatory activity and ALT levels. Antiviral therapy should be considered in mild chronic hepatitis C.
初始无/轻度肝纤维化的慢性丙型肝炎的自然史尚不确定，在疾病进展风险和抗病毒治疗需求方面存在争议。我们研究了初始轻度慢性丙型肝炎患者纤维化进展的发生率及决定因素。106例慢性丙型肝炎病毒感染患者（平均年龄41.65±12.83岁），初始肝活检无/轻度纤维化（METAVIR评分F0/F1），在未接受治疗的情况下进行前瞻性随访，5年或更长时间后（平均间隔7.8±1.51年）重复进行活检。将出现纤维化进展的患者与未进展者的基线和随访参数进行比较。64例患者（60.4%）出现纤维化进展，其中27例F0患者中有13例（49%），79例F1患者中有51例（65%）。最初为F1的患者中，36%进展至F3或肝硬化。纤维化进展（每年纤维化变化量）与年龄（P<0.0001）、基线及随访时的丙氨酸氨基转移酶（ALT）水平（P=0.005）、组织学活动度（P=0.004）、初始活检时的脂肪变性（P=0.002）以及饮酒情况（P=0.008）相关。因此，在5至10年内，三分之二初始为轻度慢性丙型肝炎的患者会出现肝纤维化进展，三分之一初始为F1的患者会发展为重度纤维化/肝硬化。年龄较大和饮酒会促进纤维化，且与炎症活动度和ALT水平相关。对于轻度慢性丙型肝炎应考虑抗病毒治疗。
