Interferon-induced prolonged biochemical response reduces hepatocarcinogenesis in hepatitis C virus infection
Interferon-induced prolonged biochemical response reduces hepatocarcinogenesis in hepatitis C virus infection
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DOI：
10.1002/jmv.20925
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发表时间：
2007-10-01
影响因子：
12.7
通讯作者：
Kumada, Hiromitsu
中科院分区：
文献类型：
--
作者：
Arase, Yasuji;Ikeda, Kenji;Kumada, Hiromitsu
本研究的目的是阐明干扰素（IFN）治疗在治疗期间不根除丙型肝炎病毒（HCV） RNA的情况下减少慢性丙型肝炎患者肝细胞癌（HCC）的指标。纳入标准为活检证实的慢性肝炎或肝硬化，干扰素治疗期超过1.5年，干扰素治疗期间HCV-RNA持续阳性。236例符合上述标准的患者接受干扰素治疗1.5-5年（中位1.8年，平均2年）。平均年龄55.1岁，男性145岁（61%）。81例（34%）患者有严重的肝纤维化。这些患者在终止干扰素治疗后对HCC进行前瞻性监测。我们将生化反应（BR）视为IFN治疗期间超过1年的血清转氨酶和甲胎蛋白的正常化。终止干扰素治疗后第5年HCC的累积发展率为9.11%，第10年为26.5%。Cox比例分析显示，终止IFN治疗后HCC发生在组织学分期提前（P < 0.0001）， BR未达到（P=0.009），年龄为60岁（P=0.026）。与没有BR的患者相比，BR患者发生HCC的相对风险为0.36。在干扰素治疗期间达到BR可有效降低慢性HCV感染患者的肝癌发生。
The aim of this study was to elucidate indicator of interferon (IFN) therapy for reducing hepatocellular carcinoma (HCC) in chronic hepatitis C patients without eradicating hepatitis C virus (HCV) RNA during IFN therapy. Inclusion criteria were biopsy-proven chronic hepatitis or liver cirrhosis, IFN period for more than 1.5 years and persistently positive HCV-RNA during IFN therapy. Two hundred thirty-six patients satisfied above criteria were treated with IFN for 1.5-5 years (median 1.8 years, mean 2 years). Mean age was 55.1 years and male was 145(61%). Eighty-one (34%) patients had severe fibrosis of the liver. These patients were prospectively monitored about HCC after the termination of IFN therapy. We regarded biochemical response (BR) as normalization of serum aminotransferase and alpha-fetoprotein for more than 1 year during IFN therapy. Cumulative rate of development of HCC after the termination of IFN therapy was 9.11% at 5th year and 26.5% at 10th year. Cox proportional analysis showed that HCC development after the termination of IFN therapy occurred when histological staging was advanced (P < 0.0001) and BR was not achieved (P=0.009), age was > 60 years (P=0.026). The relative risk of HCC development in patients with BR was 0.36 compared with patients without BR. The attainment of BR during IFN therapy is effective in reducing hepatocarcinogenesis for patients with chronic HCV infection.