Huang Chung-Feng, Huang Ching-I, Yeh Ming-Lun, Hou Chen, Hou Nai-Jen, Hsieh Ming-Yen, Huang Jee-Fu, Chen Shinn-Cherng, Lin Zu-Yau, Dai Chia-Yen, Chuang Wan-Long, Yu Ming-Lung
Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Faculty of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung, Taiwan.
J Gastroenterol Hepatol. 2017 Apr;32(4):864-869. doi: 10.1111/jgh.13600.
BACKGROUND/AIMS: The erythropoiesis in hepatitis C virus infection is unclear. We aimed to evaluate the erythropoietic components in chronic hepatitis C (CHC) patients.
The red blood cell (RBC) components, serum erythropoietin (EPO) levels, and their relationship to clinical characteristics were evaluated between 124 age-matched and sex-matched healthy controls and 248 histology-proven CHC patients.
Chronic hepatitis C patients had significantly higher serum levels of EPO (1.44 ± 0.36 log mIU/mL versus 1.03 ± 0.31 log mIU/mL, P < 0.0001) and lower hemoglobin (Hb) concentrations (14.6 ± 1.4 g/dL versus 15.3 ± 1.2 g/dL, P < 0.001) as compared with healthy controls. Among the CHC patients, the serum EPO level was negatively associated with the Hb concentration (β = -0.227; 95% confidence intervals [CI]: -0.09-0.027; P < 0.001) and RBC counts (β = -0.204; 95% CI: -0.245-0.061; P = 0.001) and was positively correlated with necroinflammatory activity (β = 0.201; 95% CI: 0.009-0.046; P = 0.003) and fibrosis (β = 0.143; 95% CI: 0.003-0.076; P = 0.04) of liver histopathology. For non-cirrhotic CHC patients, the severity of liver necroinflammatory activity was positively correlated with the reticulocyte and serum EPO levels (P = 0.001 and 0.008, respectively), and negatively related to the RBC counts (P = 0.03). Using stepwise multivariate linear regression analysis, the grade of necroinflammatory activity was positive (β = 0.214; 95% CI: 0.046-0.209, P = 0.002), whereas the Hb concentration was inversely (β = -0.205; 95% CI: -0.09-0.018, P = 0.004) associated with the serum EPO levels in CHC patients.
The disease activity in CHC patients had a negative impact on erythropoiesis with compensatory higher but blunted EPO responses.
背景/目的：丙型肝炎病毒感染中的红细胞生成情况尚不清楚。我们旨在评估慢性丙型肝炎（CHC）患者的红细胞生成成分。
在124名年龄和性别匹配的健康对照者与248名经组织学证实的CHC患者之间，评估红细胞（RBC）成分、血清促红细胞生成素（EPO）水平及其与临床特征的关系。
与健康对照者相比，慢性丙型肝炎患者的血清EPO水平显著更高（1.44±0.36 log mIU/mL对1.03±0.31 log mIU/mL，P<0.0001），血红蛋白（Hb）浓度更低（14.6±1.4 g/dL对15.3±1.2 g/dL，P<0.001）。在CHC患者中，血清EPO水平与Hb浓度呈负相关（β=-0.227；95%置信区间[CI]：-0.09 - 0.027；P<0.001）和RBC计数呈负相关（β=-0.204；95%CI：-0.245 - 0.061；P=0.001），且与肝组织病理学的坏死性炎症活动呈正相关（β=0.201；95%CI：0.009 - 0.046；P=0.003）以及纤维化呈正相关（β=0.143；95%CI：0.003 - 0.076；P=0.04）。对于非肝硬化CHC患者，肝脏坏死性炎症活动的严重程度与网织红细胞和血清EPO水平呈正相关（分别为P=0.001和0.008），与RBC计数呈负相关（P=0.03）。采用逐步多元线性回归分析，坏死性炎症活动分级呈正相关（β=0.214；95%CI：0.046 - 0.209，P=0.002），而Hb浓度与CHC患者的血清EPO水平呈负相关（β=-0.205；95%CI：-0.09 - 0.018，P=0.004）。
CHC患者的疾病活动对红细胞生成有负面影响，EPO反应虽有代偿性升高但减弱。
