Asselah T, Boyer N, Ripault M P, Martinot M, Marcellin P
Service d'Hépathologie and INSERM U 773, University of Paris VII, Beaujon Hospital, Clichy, France.
Minerva Gastroenterol Dietol. 2007 Mar;53(1):9-23.
Chronic hepatitis C is a major cause of cirrhosis and primary liver cancer (hepatocellular carcinoma). Decompensated cirrhosis or hepatocellular carcinoma secondary to hepatitis C is the first cause of liver transplantation in Europe and in the United States. The prognosis of chronic hepatitis C depends on the progression of fibrosis which determines the risk of developing cirrhosis and its complications. Knowledge of the natural history and the factors associated with the progression of fibrosis is essential for the patient's management. The risk of the progression of fibrosis is difficult to predict in one particular patient. Liver biopsy remains the best test to evaluate the severity of fibrosis, determine its prognosis and discuss the therapeutic options. At present, in a patient with hepatitis C, combined therapy associating pegylated alpha interferon and ribavirin results in a sustained response in approximately 55% of cases. Based on existing results, the sustained virological response with this treatment option appears to be long lasting, to be associated with a histological benefit and is also probably associated with a reduction in the risk of cirrhosis and hepatocellular carcinoma. The management of hepatitis C virus infections must include better knowledge of the natural history of the disease and existing available antiviral treatments (pegylated interferon and ribavirin) as well as in depth knowledge of the aims of treatment, the results obtained, the predictive factors of response and side effects. With close follow-up, doses can be rapidly modified and erythropoietin more frequently administered; new molecules may also be developed in this context. This paper will discuss the natural history, the factors associated with the progression of fibrosis, the predictive factors of response to treatment, and existing and future treatments for hepatitis C.
慢性丙型肝炎是肝硬化和原发性肝癌（肝细胞癌）的主要病因。在欧洲和美国，丙型肝炎继发的失代偿期肝硬化或肝细胞癌是肝移植的首要病因。慢性丙型肝炎的预后取决于纤维化的进展情况，而纤维化的进展决定了发生肝硬化及其并发症的风险。了解纤维化的自然病程以及与纤维化进展相关的因素对于患者的管理至关重要。在某一特定患者中，纤维化进展的风险很难预测。肝活检仍然是评估纤维化严重程度、确定其预后并探讨治疗方案的最佳检查方法。目前，对于丙型肝炎患者，聚乙二醇化α干扰素和利巴韦林联合治疗在大约55%的病例中可产生持续应答。基于现有结果，这种治疗方案的持续病毒学应答似乎具有持久性，与组织学改善相关，并且可能还与肝硬化和肝细胞癌风险的降低有关。丙型肝炎病毒感染的管理必须包括对疾病自然病程和现有抗病毒治疗方法（聚乙二醇化干扰素和利巴韦林）的深入了解，以及对治疗目标、所获结果、应答预测因素和副作用的深入认识。通过密切随访，可以迅速调整剂量并更频繁地使用促红细胞生成素；在此背景下也可能研发出新的药物分子。本文将讨论丙型肝炎的自然病程、与纤维化进展相关的因素、治疗应答的预测因素以及丙型肝炎的现有和未来治疗方法。
