Serviço de Gastrenterologia e Hepatologia, Hospital de Santa Maria, Faculdade de Medicina, Universidade de Lisboa, Av Professor Egas Moniz, 1649-035 Lisbon, Portugal.
Dig Dis Sci. 2011 Jun;56(6):1853-61. doi: 10.1007/s10620-011-1621-2. Epub 2011 Mar 5.
The effect of a sustained virological response (SVR) to interferon (IFN) on clinical outcomes of hepatitis C virus (HCV)-related cirrhosis is controversial.
Evaluate the effect of SVR to IFN on the incidence of hepatocellular carcinoma (HCC) and mortality in patients with compensated HCV-induced cirrhosis.
A cohort of 130 consecutive patients (92 men, mean age 51.7 years) with histologically proven cirrhosis who received one or more courses of IFN monotherapy or combination therapy with ribavirin were analyzed. SVR was defined as undetectable serum HCV RNA by real-time polymerase chain reaction (PCR) 24 weeks after IFN discontinuation. HCC was assessed by alfa-fetoprotein and ultrasound every 6 months. Predictors of clinical outcomes, defined as HCC, orthotopic liver transplantation (OLT) and mortality, were assessed by Cox regression analysis.
The mean follow-up was 6.4 ± 4.0 years (range 1-18). HCC developed in 21 patients: one with SVR versus 20 with non-SVR (P = 0.017). Logistic regression analysis showed that non-SVR (odds ratio [OR] = 27.0; confidence interval [CI], 1.6-452.1), male (OR = 11.6; CI, 1.8-75.4), and greater number of treatments (OR = 4.7; CI, 1.4-16.0) increased the probability of HCC development. Multivariate analysis found that SVR was associated with lower risk of HCC (HR 0.09; CI, 0.01-0.77), OLT (HR 0.04; CI, 0.003-0.63) and any event (HR 0.11; CI, 0.02-0.46) as compared to non-SVR.
In compensated HCV-related cirrhosis, SVR markedly reduces the risk of HCC and improves survival. Clearance of the virus should be intensively attempted in these patients.
干扰素（IFN）持续病毒学应答（SVR）对丙型肝炎病毒（HCV）相关肝硬化临床结局的影响存在争议。
评估 IFN 治疗 SVR 对代偿性 HCV 诱导肝硬化患者肝细胞癌（HCC）发生率和死亡率的影响。
对 130 例经组织学证实的肝硬化患者进行了一项队列研究，这些患者接受了一次或多次 IFN 单药或利巴韦林联合治疗。SVR 定义为 IFN 停药 24 周后实时聚合酶链反应（PCR）检测到血清 HCV RNA 不可检测。每隔 6 个月通过甲胎蛋白和超声评估 HCC。通过 Cox 回归分析评估 HCC、原位肝移植（OLT）和死亡率等临床结局的预测因素。
平均随访时间为 6.4±4.0 年（范围 1-18 年）。21 例患者发生 HCC：1 例 SVR 患者和 20 例非 SVR 患者（P=0.017）。Logistic 回归分析显示，非 SVR（比值比[OR] = 27.0；置信区间[CI]，1.6-452.1）、男性（OR = 11.6；CI，1.8-75.4）和治疗次数较多（OR = 4.7；CI，1.4-16.0）增加了 HCC 发生的概率。多因素分析发现，与非 SVR 相比，SVR 与 HCC（HR 0.09；CI，0.01-0.77）、OLT（HR 0.04；CI，0.003-0.63）和任何事件（HR 0.11；CI，0.02-0.46）的风险降低相关。
在代偿性 HCV 相关肝硬化中，SVR 可显著降低 HCC 风险并改善生存率。应在这些患者中积极尝试清除病毒。
