Department of Gastroenterology, Kitasato University School of Medicine, Kanagawa, Japan.
Hepatol Res. 2008 Jun;38(6):546-56. doi: 10.1111/j.1872-034X.2007.00316.x. Epub 2008 Jan 2.
Recent studies have suggested that an occult hepatitis B virus (HBV) infection negative for HBsAg but positive for HBV-DNA contributes to hepatocellular carcinoma (HCC) development in patients with chronic hepatitis C. Some follow-up studies have suggested the clinical importance of occult HBV infections in HCC development even after interferon (IFN) therapy, but a recent study denies the significance of the impact of occult HBV infection. Focusing on HCC development in patients in whom hepatitis C virus (HCV) eradication by interferon (IFN) therapy had failed, we conducted this study in order to assess the impact of occult HBV infections on HCC development in these patients.
We enrolled 141 patients with chronic hepatitis C (histological stage F2 or F3) who were seropositive for HCV-RNA even after IFN therapy. Serum HBV-DNA was assayed using the real-time polymerase chain reaction. During follow-up, ultrasonography and/or computed tomography (CT) were performed at least every 6 months to monitor HCC development.
The cumulative incidence rates of HCC were 8.9%, 25.7% and 53.7% at 5 years, 10 years and 15 years, respectively, after IFN therapy. Multivariate analysis indicated that low platelet counts (<12 x 10(4)/mm(3)), occult HBV infection, high ALT levels (>/=80 IU/L) after IFN therapy and the staging of liver fibrosis were important independent factors affecting the appearance of HCC.
Occult HBV was a risk factor for HCC development in patients with chronic hepatitis C in whom HCV eradication had failed. Therefore, patients with chronic hepatitis C with occult HBV should be monitored carefully for HCC after IFN therapy.
最近的研究表明，乙型肝炎病毒（HBV）隐匿性感染（HBsAg 阴性但 HBV-DNA 阳性）在慢性丙型肝炎患者中导致肝细胞癌（HCC）的发展。一些随访研究表明，即使在干扰素（IFN）治疗后，隐匿性 HBV 感染在 HCC 发展中的临床重要性，但最近的一项研究否认了隐匿性 HBV 感染的影响的意义。本研究针对因 IFN 治疗而未能清除丙型肝炎病毒（HCV）的 HCC 发展患者，旨在评估隐匿性 HBV 感染对这些患者 HCC 发展的影响。
我们纳入了 141 例慢性丙型肝炎（组织学 F2 或 F3 期）患者，这些患者即使在 IFN 治疗后仍为 HCV-RNA 阳性。采用实时聚合酶链反应检测血清 HBV-DNA。在随访期间，超声检查和/或计算机断层扫描（CT）至少每 6 个月进行一次，以监测 HCC 的发展。
IFN 治疗后 5 年、10 年和 15 年时 HCC 的累积发生率分别为 8.9%、25.7%和 53.7%。多变量分析表明，血小板计数低（<12×10(4)/mm(3)）、隐匿性 HBV 感染、IFN 治疗后 ALT 水平升高（≥80IU/L）和肝纤维化分期是影响 HCC 发生的重要独立因素。
隐匿性 HBV 是慢性丙型肝炎患者中 HCV 清除失败后 HCC 发展的危险因素。因此，慢性丙型肝炎伴隐匿性 HBV 的患者在 IFN 治疗后应密切监测 HCC。
