George Sarah L, Bacon Bruce R, Brunt Elizabeth M, Mihindukulasuriya Kusal L, Hoffmann Joyce, Di Bisceglie Adrian M
Department of Internal Medicine, Division of Gastroenterology, Saint Louis University Liver Center, St Louis, MO, USA.
Hepatology. 2009 Mar;49(3):729-38. doi: 10.1002/hep.22694.
One hundred fifty patients with sustained virologic response (SVR) after treatment of chronic hepatitis C were enrolled in a long-term clinical follow-up study; patients were followed for 5 years for liver-related outcomes and evidence of biochemical or virologic relapse. Patients with stage 2 or greater fibrosis on pretreatment biopsy were invited to undergo a long-term follow-up biopsy after their fourth year of follow-up. One hundred twenty-eight patients (85%) were followed through their fourth year, and long-term follow-up biopsies were obtained from 60 patients (40%). Forty-nine patients had paired pretreatment and long-term follow-up biopsies blindly rescored. Forty of these patients (82%) had a decrease in fibrosis score, and 45 (92%) had a decrease in combined inflammation score. Ten patients (20%) had normal or nearly normal livers on long-term follow-up biopsy. Two patients with pretreatment cirrhosis developed hepatocellular carcinoma (HCC), and one died. All the other patients with pretreatment cirrhosis or advanced fibrosis had improved fibrosis scores on long-term follow-up biopsy. No patient had conclusive evidence of virologic relapse. Three patients had persistently elevated alanine aminotransferase levels; two of these had new liver disease.
In a cohort of 150 patients with SVR followed for 5 years, the majority of patients had good outcomes. Serum virologic relapse was not seen, but two patients with pretreatment cirrhosis developed HCC, and one died. In a blind rescoring of 49 paired pretreatment and long-term follow-up biopsies, 82% improved fibrosis scores and 92% improved at least one component of inflammation. A minority of patients had normal or nearly normal liver tissue on long-term follow-up biopsy. Patients with cirrhosis pretreatment are at a low but real risk of HCC after SVR.
150例慢性丙型肝炎治疗后获得持续病毒学应答（SVR）的患者被纳入一项长期临床随访研究；对患者进行了5年的随访，以观察肝脏相关结局以及生化或病毒学复发的证据。预处理活检显示纤维化程度为2期或更高的患者在随访第4年后被邀请接受长期随访活检。128例患者（85%）完成了4年的随访，60例患者（40%）接受了长期随访活检。49例患者的预处理活检和长期随访活检被进行了盲法重新评分。其中40例患者（82%）纤维化评分下降，45例患者（92%）综合炎症评分下降。10例患者（20%）在长期随访活检时肝脏正常或接近正常。2例预处理时为肝硬化的患者发生了肝细胞癌（HCC），1例死亡。所有其他预处理时为肝硬化或重度纤维化的患者在长期随访活检时纤维化评分均有改善。没有患者有病毒学复发的确切证据。3例患者丙氨酸氨基转移酶水平持续升高；其中2例有新发肝病。
在150例获得SVR并随访5年的患者队列中，大多数患者预后良好。未观察到血清病毒学复发，但2例预处理时为肝硬化的患者发生了HCC，1例死亡。在对49例配对的预处理活检和长期随访活检进行盲法重新评分时，82%的患者纤维化评分改善，92%的患者至少一项炎症指标改善。少数患者在长期随访活检时肝脏组织正常或接近正常。预处理时为肝硬化的患者在SVR后发生HCC的风险较低但确实存在。
