Takahashi Aya, Shima Toshihide, Kinoshita Naohiko, Yano Kota, Ueno Tomoko, Nishiwaki Masatake, Yamamoto Yasuhide, Oya Hirohisa, Amano Ichiro, Matsumoto Junko, Mitsumoto Yasuhide, Tanaka Izumi, Sakai Kyoko, Sawai Naoki, Mizuno Chiemi, Mizuno Masayuki, Itoh Yoshito, Okanoue Takeshi
Department of Gastroenterology, Osaka Saiseikai Suita Hospital.
Department of Clinical Laboratory, Osaka Saiseikai Suita Hospital.
Nihon Shokakibyo Gakkai Zasshi. 2018;115(2):184-194. doi: 10.11405/nisshoshi.115.184.
Since the introduction of direct-acting antiviral (DAA)-based combination therapies in September 2014 for patients with chronic hepatitis-C (CH-C), numerous patients have been diagnosed with hepatitis-C virus (HCV)-associated hepatocellular carcinomas (HCCs) during the screening performed prior to DAA therapy. The present study was conducted on the antiviral therapy for CH-C in two phases:i) the interferon (IFN) phase between January 2011 and August 2014 and ii) the DAA phase between September 2014 and September 2016. During the DAA phase, HCCs were detected in eight patients who were referred to our hospital for anti-HCV therapy. In contrast, HCCs were detected in only two patients during the IFN phase. The number of patients with newly detected HCC in the DAA phase (20.5%) who were referred for the anti-HCV therapy was significantly higher than that in the IFN phase (1.7%). Owing to the high efficacy and safety of the DAA therapy, the number of patients referred to our hospital for anti-HCV therapy increased from 40.5 persons/year in the IFN phase to 80.3 persons/year in the DAA phase. The average ages of patients in the DAA and IFN phases were 68 and 61 years, respectively. The increase in the number of patients with newly detected HCC referred for the anti-HCV therapy in the DAA phase could be attributed to the increase in the number of referred patients for anti-HCV therapy and the aging of these patients in the DAA phase. All the eight patients with newly detected HCC who were referred for anti-HCV therapy in the DAA phase received curative treatments. The median age, rate of liver cirrhosis, and median tumor size of the patients were 69 years, 13%, and 16mm. Therefore, the findings of this study indicate that DAA therapies not only eradicate HCV infection but also contribute to the early diagnosis of HCC by encouraging the HCV-infected patients to visit hospitals and by promoting active network between hepatologists and family physicians.
自2014年9月针对慢性丙型肝炎（CH-C）患者引入基于直接抗病毒药物（DAA）的联合疗法以来，许多患者在DAA治疗前进行的筛查中被诊断出患有丙型肝炎病毒（HCV）相关的肝细胞癌（HCC）。本研究分两个阶段对CH-C的抗病毒治疗进行：i）2011年1月至2014年8月的干扰素（IFN）阶段，以及ii）2014年9月至2016年9月的DAA阶段。在DAA阶段，有8名因抗HCV治疗转诊至我院的患者被检测出患有HCC。相比之下，在IFN阶段仅有2名患者被检测出患有HCC。转诊接受抗HCV治疗的患者中，DAA阶段新检测出HCC的患者数量（20.5%）显著高于IFN阶段（1.7%）。由于DAA疗法具有高效性和安全性，转诊至我院接受抗HCV治疗的患者数量从IFN阶段的每年40.5人增加到DAA阶段的每年80.3人。DAA阶段和IFN阶段患者的平均年龄分别为68岁和61岁。DAA阶段转诊接受抗HCV治疗的新检测出HCC患者数量的增加可能归因于转诊接受抗HCV治疗的患者数量增加以及DAA阶段这些患者的老龄化。DAA阶段转诊接受抗HCV治疗的所有8名新检测出HCC的患者均接受了根治性治疗。患者的中位年龄、肝硬化发生率和中位肿瘤大小分别为69岁、13%和16mm。因此，本研究结果表明，DAA疗法不仅能根除HCV感染，还通过鼓励HCV感染患者就医以及促进肝病专家与家庭医生之间的积极联系，有助于HCC的早期诊断。
