Department of Gastroenterology and Hepatology, Osaka-Rosai Hospital, Sakai, Osaka, Japan.
Hepatol Commun. 2021 Dec;5(12):2001-2008. doi: 10.1002/hep4.1782. Epub 2021 Aug 3.
We have reported that the plasma zinc concentration gradually decreases with the progression of fibrosis and is related to hepatocellular carcinoma (HCC) development. The aim of this study was to examine the impact of the zinc concentration on HCC development (study 1) and the relationship between zinc intake and HCC development (study 2) in patients with hepatitis C virus (HCV) eradicated by direct-acting antivirals (DAAs). A total of 599 sustained virological response (SVR) patients treated with DAAs without a history of HCC were retrospectively analyzed in this study. Eighty patients received supplemental zinc (Zn treatment group), and 519 patients did not receive zinc (no Zn treatment group). In study 1, the cumulative incidence rate of HCC was compared between the Zn treatment group and the no Zn treatment group. In study 2, the risk factors for HCC development were examined in the no Zn treatment group. In study 1, in the Zn treatment group, HCC did not develop during follow-up, and the cumulative risk of HCC was significantly lower in the Zn treatment group than in the no Zn treatment group (P = 0.048). In study 2, the 1-year and 3-year cumulative incidence rates of HCC were 1.8% and 5.6%, respectively. The risk factors for HCC identified by multivariate analysis were male sex, cirrhosis, low platelet count before treatment, and low serum zinc concentration 12 weeks after the end of DAA therapy. Conclusion: The Zn concentration is related to HCC development in patients with HCV eradicated by DAA therapy. Oral zinc supplementation is recommended as a means of suppressing HCC development in patients who have achieved SVR.
我们曾报道过，血浆锌浓度随着纤维化的进展逐渐降低，且与肝细胞癌（HCC）的发生有关。本研究旨在探讨锌浓度对接受直接作用抗病毒药物（DAA）治疗后丙型肝炎病毒（HCV）清除患者 HCC 发生的影响（研究 1），以及锌摄入量与 HCC 发生的关系（研究 2）。本研究回顾性分析了 599 例无 HCC 病史且接受 DAA 治疗后获得持续病毒学应答（SVR）的患者。80 例患者接受了补锌治疗（Zn 治疗组），519 例患者未补锌（无 Zn 治疗组）。在研究 1 中，比较了 Zn 治疗组和无 Zn 治疗组的 HCC 累积发生率。在研究 2 中，在无 Zn 治疗组中，检查了 HCC 发生的危险因素。在研究 1 中，Zn 治疗组在随访期间未发生 HCC，且 Zn 治疗组 HCC 的累积风险显著低于无 Zn 治疗组（P=0.048）。在研究 2 中，HCC 的 1 年和 3 年累积发生率分别为 1.8%和 5.6%。多因素分析确定的 HCC 发生的危险因素为男性、肝硬化、治疗前血小板计数低和 DAA 治疗结束后 12 周血清锌浓度低。结论：DAA 治疗清除 HCV 后，锌浓度与 HCC 的发生有关。建议对获得 SVR 的患者进行口服补锌治疗，以抑制 HCC 的发生。
