Shindo M, Arai K, Sokawa Y, Okuno T
Akashi Municipal Hospital, Japan.
Ann Intern Med. 1995 Apr 15;122(8):586-91. doi: 10.7326/0003-4819-122-8-199504150-00005.
To identify predictors of a long-term response to interferon-alpha therapy in chronic hepatitis C and to determine whether hepatitis C virus (HCV) was eradicated in patients with chronic hepatitis C who had a long-term response to therapy.
A retrospective analysis.
In- and outpatient liver clinic of a municipal hospital in Japan.
47 patients with chronic hepatitis C who responded to interferon-alpha were divided into two groups: 22 patients with a long-term response (serum aminotransferase levels remained normal for > 1 year after therapy) and 25 patients with a short-term response (serum aminotransferase levels increased again after therapy).
Genotyping of HCV, titers of HCV RNA in liver and serum samples (using the reverse transcriptase-polymerase chain reaction), histologic activity index, and liver histologic tests during and 1 year after therapy.
Among the 22 long-term responders, HCV RNA was no longer detectable in liver and serum samples of 21 (95%) at the end of therapy and remained undetectable in the serum of 20 (91%) and in the liver of 19 (86%) 1 year after therapy. Liver histologic tests improved substantially immediately after therapy and 1 year after therapy in the long-term responders; however, 18 (82%) of these patients still had mild, chronic hepatitis. Among the 25 short-term responders, HCV RNA was still detected in the liver of 19 (76%) and in the serum of 9 (36%) at the end of therapy. Multivariate logistic regression analysis showed that the persistent presence of hepatic HCV RNA at the end of therapy was the strongest predictor of relapse.
These findings suggest that HCV infection was eradicated in most of the long-term responders to interferon-alpha therapy because HCV RNA could no longer be detected in their serum and liver samples and because a significant improvement gradually occurred in their liver histologic results. The persistent presence of hepatic HCV RNA at the end of therapy was the most important predictor of relapse.
确定慢性丙型肝炎患者对α干扰素治疗长期反应的预测因素，并确定在对治疗有长期反应的慢性丙型肝炎患者中丙型肝炎病毒（HCV）是否被根除。
回顾性分析。
日本一家市立医院的门诊和住院肝病诊所。
47例对α干扰素治疗有反应的慢性丙型肝炎患者被分为两组：22例有长期反应者（治疗后血清转氨酶水平保持正常超过1年）和25例有短期反应者（治疗后血清转氨酶水平再次升高）。
HCV基因分型、肝和血清样本中HCV RNA滴度（使用逆转录聚合酶链反应）、组织学活性指数以及治疗期间和治疗后1年的肝脏组织学检查。
在22例长期反应者中，治疗结束时21例（95%）的肝和血清样本中不再能检测到HCV RNA，治疗后1年，20例（91%）的血清和19例（86%）的肝脏中仍未检测到HCV RNA。长期反应者治疗后即刻和治疗后1年肝脏组织学检查有显著改善；然而，这些患者中有18例（82%）仍有轻度慢性肝炎。在25例短期反应者中，治疗结束时19例（76%）的肝脏和9例（36%）的血清中仍能检测到HCV RNA。多因素逻辑回归分析显示，治疗结束时肝脏中HCV RNA的持续存在是复发的最强预测因素。
这些发现表明，大多数对α干扰素治疗有长期反应的患者中HCV感染被根除，因为其血清和肝脏样本中不再能检测到HCV RNA，且肝脏组织学结果逐渐有显著改善。治疗结束时肝脏中HCV RNA的持续存在是复发的最重要预测因素。
