Predictors of alpha-fetoprotein elevation in patients with chronic hepatitis C, but not hepatocellular carcinoma, and its normalization after pegylated interferon alfa 2a-ribavirin combination therapy
Predictors of alpha-fetoprotein elevation in patients with chronic hepatitis C, but not hepatocellular carcinoma, and its normalization after pegylated interferon alfa 2a-ribavirin combination therapy
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DOI：
10.1111/j.1440-1746.2007.04898.x
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发表时间：
2007-05-01
影响因子：
4.1
通讯作者：
Tung, Jai-Nien
中科院分区：
文献类型：
--
作者：
Chen, Tsung-Ming;Huang, Pi-Teh;Tung, Jai-Nien
背景和目的：慢性丙型肝炎(CHC)患者血清甲胎蛋白(AFP)水平升高。聚乙二醇化干扰素和利巴韦林(Peg-IFN/RBV)联合治疗后AFP水平的变化仍不清楚。本研究的目的是探讨慢性丙型肝炎患者血清甲胎蛋白升高的预测因素，以及在聚乙二醇化干扰素/RBV治疗后甲胎蛋白水平的变化。83名患者接受了完整的治疗，并接受了24周以上的随访。结果：甲胎蛋白水平平均为18.5+/-63.0 ng/m L(1.3~676.0 ng/m L)，其中41例(33.3%)治疗前甲胎蛋白升高(>10 ng/m L)。多因素Logistic回归分析显示，年龄越大(优势比[OR]，1.093；95%可信区间[CI]，1.015~1.177；P=0.018)，肝纤维化分期越晚期(OR，5.237；95%CI，1.244~22.037；P=0.024)，天冬氨酸氨基转移酶(IU/L)水平越高(OR，1.020；95%CI，1.008~1.033；P=0.001)，血小板计数越低(x10(9)/L，OR，0.985；95%可信区间0.968~0.994；P=0.003)是治疗前甲胎蛋白升高的独立影响因素。83例中72例(86.7%)治疗后甲胎蛋白(AFP)水平在随访结束(EOF)时恢复正常。治疗后慢性丙型肝炎病毒核糖核酸阴性(OR，10.014；95%CI，1.000~100.329；P=0.050)和治疗后血小板计数(x10(9)/L)(OR，1.025；95%CI，1.001~1.050；P=0.040)与甲胎蛋白正常相关。AFP逐渐下降，从治疗后12周到治疗结束有显著差异，持续病毒应答(SVR)组的AFP在EOF日期最低。相反，非SVR组在治疗过程中和治疗后没有AFP的变化。结论：年龄大、低血小板计数、较高的AST水平和晚期纤维化易导致非肝细胞癌的慢性丙型肝炎患者血清AFP水平升高。经Peg-干扰素/RBV联合治疗后，血小板计数升高和丙型肝炎病毒清除是EOF时AFP正常的决定因素。系列甲胎蛋白水平在治疗后下降，呈现时间依赖的方式，特别是在SVR组。
Background and Aim: Elevated serum alpha-fetoprotein (AFP) levels are noted in patients with chronic hepatitis C (CHC) without hepatocellular carcinoma (HCC). The change in AFP levels after treatment with pegylated interferon and ribavirin (Peg-IFN/RBV) combination therapy is still unknown. The aim of this study was to investigate the predictors of elevated serum AFP in patients with CHC, and its change after Peg-IFN/RBV therapy.Methods: A total of 123 patients, intended to receive pegylated interferon alfa-2a plus ribavirin therapy, were enrolled. Eighty-three patients had complete treatment and received follow up for and additional 24 weeks. The factors that may affect the elevation of pretreatment AFP and the normalization of post-treatment AFP were determined.Results: The mean AFP level was 18.5 +/- 63.0 ng/mL (range, 1.3-676.0 ng/mL); 41 (33.3%) of the 123 patients had elevated serum AFP (more than 10 ng/mL) at baseline. A multivariate logistic regression analysis disclosed that older age (odds ratio [OR], 1.093; 95% confidence interval [CI], 1.015-1.177; P = 0.018), more advanced METAVIR fibrosis stage (OR, 5.237; 95% CI, 1.244-22.037; P = 0.024), a higher aspartate aminotransferase (AST) level (IU/L) (OR, 1.020; 95% CI, 1.008-1.033; P = 0.001), and lower platelet count (x10(9)/L, OR, 0.985; 95% CI, 0.968-0.994; P = 0.003) were independent determinants of pretreatment AFP elevation. After treatment, 72 of 83 (86.7%) cases were found to have normal post-treatment AFP levels (< 10 ng/mL) at the end of follow up (EOF). Post-treatment negativity of the chronic hepatitis C virus (HCV)-RNA (OR, 10.014; 95% CI, 1.000-100.329; P = 0.050) and the post-treatment platelet count (x10(9)/L) (OR, 1.025; 95% CI, 1.001-1.050; P = 0.040) were associated with normal AFP at EOF. AFP progressively decreased with significant differences starting from the 12th week after treatment to the end of treatment, and was lowest at the EOF date for the sustained viral response (SVR) group. On the contrary, the non-SVR group did not have an AFP change during and after treatment.Conclusion: Older age, low platelet count, higher AST levels, and advanced fibrosis predisposed chronic hepatitis C patients without HCC to have elevated serum AFP levels. After Peg-IFN/RBV combination therapy, a higher platelet count and HCV viral eradication were determinants of normal AFP at EOF. Serial AFP levels decreased after treatment, presenting in a time-dependent manner, specifically for the SVR group.