聚乙二醇干扰素治疗前后的甲胎蛋白用于预测肝细胞癌的发生
Alpha-fetoprotein before and after pegylated interferon therapy for predicting hepatocellular carcinoma development.
作者信息
Takeuchi Yasuto, Ikeda Fusao, Osawa Toshiya, Araki Yasuyuki, Takaguchi Kouichi, Morimoto Youichi, Hashimoto Noriaki, Sakaguchi Kousaku, Sakata Tatsuro, Ando Masaharu, Makino Yasuhiro, Matsumura Shuji, Takayama Hiroki, Seki Hiroyuki, Nanba Shintarou, Moritou Yuki, Yasunaka Tetsuya, Ohnishi Hideki, Takaki Akinobu, Nouso Kazuhiro, Iwasaki Yoshiaki, Yamamoto Kazuhide
机构信息
Yasuto Takeuchi, Fusao Ikeda, Hiroyuki Seki, Shintarou Nanba, Yuki Moritou, Tetsuya Yasunaka, Hideki Ohnishi, Akinobu Takaki, Kazuhiro Nouso, Kazuhide Yamamoto, Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan.
出版信息
World J Hepatol. 2015 Sep 8;7(19):2220-8. doi: 10.4254/wjh.v7.i19.2220.
AIM
To investigate factors that accurately predict hepatocellular carcinoma (HCC) development after antiviral therapy in chronic hepatitis C (CHC) patients.
METHODS
CHC patients who received pegylated interferon and ribavirin were enrolled in this cohort study that investigated the ability of alpha-fetoprotein (AFP) to predict HCC development after interferon (IFN) therapy.
RESULTS
Of 1255 patients enrolled, 665 developed sustained virological response (SVR) during mean follow-up period of 5.4 years. HCC was occurred in 89 patients, and 20 SVR patients were included. Proportional hazard models showed that HCC occurred in SVR patients showing AFP ≥ 5 ng/mL before therapy and in non-SVR patients showing AFP ≥ 5 ng/mL before and 1 year after therapy besides older age, and low platelet counts. SVR patients showing AFP ≥ 5 ng/mL before therapy and no decrease in AFP to < 5 ng/mL 1 year after therapy had significantly higher HCC incidence than non-SVR patients showing AFP ≥ 5 ng/mL before therapy and decreased AFP (P = 0.043). AFP ≥ 5 ng/mL before therapy was significantly associated with low platelet counts and high values of alanine aminotransferase (ALT) in stepwise logistic regression analysis. After age, gender, platelet count, and ALT was matched by propensity score, significantly lower HCC incidence was shown in SVR patients showing AFP < 5 ng/mL before therapy than in those showing AFP ≥ 5 ng/mL.
CONCLUSION
The criteria of AFP < 5 ng/mL before and 1 year after IFN therapy is a benefical predictor for HCC development in CHC patients.
目的
探讨准确预测慢性丙型肝炎（CHC）患者抗病毒治疗后肝细胞癌（HCC）发生的因素。
方法
本队列研究纳入接受聚乙二醇干扰素和利巴韦林治疗的CHC患者，研究甲胎蛋白（AFP）预测干扰素（IFN）治疗后HCC发生的能力。
结果
在纳入的1255例患者中，665例在平均5.4年的随访期内实现了持续病毒学应答（SVR）。89例患者发生HCC，其中包括20例SVR患者。比例风险模型显示，除年龄较大和血小板计数较低外，治疗前AFP≥5 ng/mL的SVR患者以及治疗前和治疗后1年AFP≥5 ng/mL的非SVR患者会发生HCC。治疗前AFP≥5 ng/mL且治疗后1年AFP未降至<5 ng/mL的SVR患者的HCC发病率显著高于治疗前AFP≥5 ng/mL且AFP下降的非SVR患者（P = 0.043）。在逐步逻辑回归分析中，治疗前AFP≥5 ng/mL与血小板计数低和丙氨酸转氨酶（ALT）值高显著相关。按倾向评分匹配年龄、性别、血小板计数和ALT后，治疗前AFP<5 ng/mL的SVR患者的HCC发病率显著低于AFP≥5 ng/mL的患者。
结论
IFN治疗前和治疗后1年AFP<5 ng/mL的标准是CHC患者HCC发生的有益预测指标。
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