Alberti Alfredo
Department of Histology, Microbiology and Medical Biotechnologies, University of Padova, Padova, Italy.
Liver Int. 2009 Jan;29 Suppl 1:15-8. doi: 10.1111/j.1478-3231.2008.01945.x.
The natural history of chronic hepatitis C has been defined in several retrospective and prospective studies conducted in the last 20 years. These studies have clearly demonstrated that the outcome of chronic hepatitis C virus infection is profoundly influenced by a variety of cofactors and comorbidities. Many of the cofactors that affect the course of liver disease in hepatitis C also have a significant influence on the result of antiviral therapy. Unfortunately, comorbidities that have been shown to negatively influence the course and outcome of liver disease often reduce the chance of achieving a sustained virological response with pegylated interferon (PEG-IFN) and ribavirin treatment. The most important and frequent comorbidity influencing the course of chronic hepatitis C and the response to antiviral therapy is represented by the metabolic syndrome, and by the associated state of insulin resistance. Other comorbidities that have a negative influence on the progression of hepatitis C and on the response to antiviral therapy include excess alcohol intake, human immunodeficiency virus and hepatitis B virus co-infection and a number of conditions that reduce the benefit of therapy by affecting negatively compliance and/or adherence to adequate PEG-IFN or ribavirin doses.
过去20年开展的多项回顾性和前瞻性研究已明确了慢性丙型肝炎的自然史。这些研究清楚地表明，慢性丙型肝炎病毒感染的转归受到多种辅助因素和合并症的深刻影响。许多影响丙型肝炎肝病进程的辅助因素对抗病毒治疗的结果也有显著影响。遗憾的是，已证明对肝病进程和转归有负面影响的合并症往往会降低聚乙二醇化干扰素（PEG-IFN）联合利巴韦林治疗实现持续病毒学应答的机会。影响慢性丙型肝炎进程及对抗病毒治疗反应的最重要且最常见的合并症是代谢综合征及相关的胰岛素抵抗状态。其他对丙型肝炎进展及对抗病毒治疗反应有负面影响的合并症包括过量饮酒、人类免疫缺陷病毒和乙型肝炎病毒合并感染，以及一些因对充分的PEG-IFN或利巴韦林剂量的依从性和/或坚持性产生负面影响而降低治疗获益的情况。
