Giustina G, Fattovich G, De Paoli M, Guido M, Favarato S, Rugge M, Alberti A, Ruol A, Plebani M
Istituto di Medicina Clinica, University of Padova, Italy.
Int J Clin Lab Res. 1996;26(1):33-6. doi: 10.1007/BF02644771.
The clinical significance of serum procollagen type III peptide, a marker of active fibrogenesis, was evaluated in 110 hepatitis B surface antigen positive patients with chronic hepatitis (32 chronic persistent hepatitis, 60 chronic active hepatitis, and 18 active cirrhosis), selected on the basis of active viral replication and biochemical activity, including 54 cases treated with interferon-alpha. At presentation the procollagen type III peptide level serum was above normal in 48 (44%) of the 110 patients and the median value was significantly higher than that of healthy carriers with normal transaminases and histology (P < 0.000005). Semiquantitative histological evaluation showed a significant correlation between serum procollagen type III peptide levels and necrosis/inflammation in the subgroup of patients with chronic active hepatitis, but no relationship with the score of fibrosis. Among patients treated with interferon-alpha and with increased fibrogenic activity (indicated by high pretreatment serum levels of procollagen type III peptide), peptide levels were significantly decreased when pretreatment levels were compared with those at 12 months after therapy withdrawal, both in responders to interferon (P = 0.022) and non-responders (P = 0.012). However, serum procollagen type III peptide levels normalized in 75% of responders to interferon with sustained serological and histological remission of liver disease, but in only 21% of non-responders (P = 0.02). These results obtained in a well-defined population suggest that serum procollagen type III peptide is a better marker of active fibrogenesis and inflammation than an indicator of the extent of fibrosis, and that interferon may reduce active liver fibrogenesis in chronic hepatitis B independently of its effect on viral replication. However, a consistent proportion (56%) of our chronic hepatitis B patients had normal serum procollagen type III peptide levels at presentation, thus precluding the clinical use of this marker both for diagnosis of liver injury and for monitoring the therapeutic response to interferon.
在110例乙肝表面抗原阳性的慢性肝炎患者（32例慢性持续性肝炎、60例慢性活动性肝炎和18例活动性肝硬化）中，评估了作为活跃纤维生成标志物的血清III型前胶原肽的临床意义。这些患者是根据活跃的病毒复制和生化活性挑选出来的，其中54例接受了α干扰素治疗。就诊时，110例患者中有48例（44%）血清III型前胶原肽水平高于正常，且中位数显著高于转氨酶和组织学正常的健康携带者（P<0.000005）。半定量组织学评估显示，在慢性活动性肝炎患者亚组中，血清III型前胶原肽水平与坏死/炎症之间存在显著相关性，但与纤维化评分无关。在接受α干扰素治疗且纤维生成活性增加（以治疗前血清III型前胶原肽水平高为指标）的患者中，无论是干扰素应答者（P=0.022）还是无应答者（P=0.012），将治疗前水平与停药后12个月时的水平相比，肽水平均显著降低。然而，在肝病血清学和组织学持续缓解的干扰素应答者中，血清III型前胶原肽水平在75%的患者中恢复正常，但在无应答者中仅为21%（P=0.02）。在这一明确界定的人群中获得的这些结果表明，血清III型前胶原肽是活跃纤维生成和炎症的更好标志物，而非纤维化程度的指标，并且干扰素可能独立于其对病毒复制的作用而减少慢性乙型肝炎中的活跃肝脏纤维生成。然而，我们的慢性乙型肝炎患者中有相当比例（56%）就诊时血清III型前胶原肽水平正常，因此该标志物无法用于肝损伤的诊断以及监测对干扰素的治疗反应。
