Shindo M, Arai K, Okuno T
Department of Internal Medicine, Akashi Municipal Hospital, Japan.
J Hepatol. 1997 Mar;26(3):492-7. doi: 10.1016/s0168-8278(97)80412-6.
BACKGROUND/AIMS: To determine the clinical usefulness of a new histological scoring system (grading and staging scores) for predicting a long-term response to interferon therapy and evaluating the efficacy of therapy, we examined biochemical, virological and histological findings during and 1 year after interferon therapy in 109 patients with chronic hepatitis C.
Hepatitis C virus RNA was assayed by reverse transcriptase polymerase chain reaction, hepatitis C virus genotype was determined by reverse transcriptase polymerase chain reaction using type-specific primers, and histological grading and staging scores were determined according to a newer scoring system.
The patients were divided into two groups according to the outcome of serum alanine aminotransferase levels and HCV RNA level during and after therapy: 31 long-term responders whose serum aminotransferase level became and remained normal for 1 year after therapy with undetectable HCV RNA in serum and liver and 78 non-responders whose aminotransferase levels did not normalize during therapy or rose again after therapy. Before therapy, the long-term responders had significantly lower viral levels, lower incidence of genotype 1b, and lower staging scores than those of the non-responders. There was no significant difference in grading score between the long-term and non-responders. Multivariate analysis showed that the viral level and genotype are more important predictors of a long-term response than the staging score. Both grading and staging scores decreased significantly at the end of therapy in both the long-term and non-responders. The 1-year follow-up liver biopsy examination in the long-term responders showed that the grading score, but not the staging score, continued to decrease significantly.
These findings suggest that: (1) the staging score, but not the grading score, appears to be associated with a long-term response, but the viral level and genotype are more important predictors than the staging score; and (2) both the grading and staging scores decreased significantly with interferon therapy, but the staging score appeared to take longer to improve than the grading score.
背景/目的：为了确定一种新的组织学评分系统（分级和分期评分）在预测干扰素治疗的长期反应及评估治疗效果方面的临床实用性，我们对109例慢性丙型肝炎患者在干扰素治疗期间及治疗后1年的生化、病毒学和组织学结果进行了检查。
采用逆转录聚合酶链反应检测丙型肝炎病毒RNA，使用型特异性引物通过逆转录聚合酶链反应确定丙型肝炎病毒基因型，并根据一种更新的评分系统确定组织学分级和分期评分。
根据治疗期间及治疗后血清丙氨酸氨基转移酶水平和HCV RNA水平的结果，将患者分为两组：31例长期应答者，其血清氨基转移酶水平在治疗后变为正常并维持1年，血清和肝脏中HCV RNA检测不到；78例无应答者，其氨基转移酶水平在治疗期间未恢复正常或治疗后再次升高。治疗前，长期应答者的病毒水平显著低于无应答者，基因型1b的发生率较低，分期评分也较低。长期应答者和无应答者之间的分级评分无显著差异。多变量分析表明，病毒水平和基因型比分期评分更能预测长期反应。长期应答者和无应答者在治疗结束时分级和分期评分均显著下降。长期应答者的1年随访肝活检检查显示，分级评分持续显著下降，而分期评分未下降。
这些结果表明：（1）分期评分似乎与长期反应相关，而分级评分则不然，但病毒水平和基因型比分期评分更重要；（2）干扰素治疗后分级和分期评分均显著下降，但分期评分似乎比分级评分需要更长时间才能改善。
