Clinical characteristics of patients with chronic hepatitis C showing biochemical remission, without hepatitis C virus eradication, as a result of interferon therapy. The Osaka Liver Disease Study Group.
Clinical characteristics of patients with chronic hepatitis C showing biochemical remission, without hepatitis C virus eradication, as a result of interferon therapy. The Osaka Liver Disease Study Group.
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由于干扰素治疗，慢性丙型肝炎患者的临床特征显示生化缓解，但丙型肝炎病毒未根除。
作者：
A. Kasahara;N. Hayashi;K. Mochizuki;N. Hiramatsu;Y. Sasaki;S. Kakumu;K. Kiyosawa;K. Okita
在对慢性丙型肝炎病毒（HCV）感染并接受干扰素（IFN）治疗的患者进行长期随访期间，我们发现一些患者血清丙氨酸氨基转移酶（ALT）持续正常化，但HCV RNA仍呈阳性。本研究的目的是阐明这些患者的特征，并检查他们治疗后的临床结果。998例接受干扰素治疗的患者进行了13-95个月的生化学和病毒学以及肝脏超声随访。在296例患者中发现了短期生化持续应答，即在IFN治疗完成后6个月ALT保持在正常范围内;其中240例患者的血清HCV RNA在长期随访期间仍然检测不到。高病毒载量的短期生化持续应答者的HCV RNA持续存在率是低病毒载量者的7.09倍（P=0.0001，比值比[OR]=7.09），和3. 70-大剂量IFN治疗组比小剂量IFN治疗组低1倍（P=0.02，OR=0.27）。56例未根除HCV的患者中有33例（59%）在停止IFN治疗后持续ALT正常化26-80个月。年龄较大（P=0.009，OR=10.43）和男性（P=0.03，OR=6.98）的短期生化持续应答者维持正常ALT水平的概率显著更大，即使血清HCV RNA为阳性。在长期随访期间对未根除HCV的患者进行HCC发病率调查时，发现ALT水平持续正常的患者的HCC发病率显著低于ALT水平异常的患者（P=0.03）。因此，当干扰素治疗不能根除HCV时，可能会在老年或男性患者中诱导ALT水平正常的HCV感染长期携带状态，其中HCC的累积发病率显著降低。
During long-term follow-up of patients chronically infected with the hepatitis C virus (HCV) and treated with interferon (IFN), we identified some who had persistent normalization of serum alanine aminotransferase (ALT) but remained positive for HCV RNA. The aims of this study were to clarify the characteristics of these patients and to examine their clinical outcome after treatment. Nine hundred and ninety-eight patients treated with IFN were followed-up biochemically and virologically, and by liver ultrasound, for 13-95 months. A short-term biochemical sustained response, where ALT remained within the normal range for 6 months after the completion of IFN therapy, was found in 296 patients; in 240 of these patients serum HCV RNA remained undetectable during long-term follow-up. The rate of HCV RNA persistence was 7.09 times greater in short-term biochemical sustained responders with a high viral load than in those with a low viral load (P=0.0001, odds ratio [OR]=7.09), and 3. 70-fold lower in those treated with a large dose of IFN than in those treated with a small dose (P=0.02, OR=0.27). Thirty-three (59%) of 56 patients without HCV eradication showed continuous ALT normalization for 26-80 months after cessation of IFN therapy. Short-term biochemical sustained responders who were older (P=0.009, OR=10.43) and who were male (P=0.03, OR=6.98) had a significantly greater probability of maintaining a normal ALT level, even when serum HCV RNA was positive. When the incidence of HCC was investigated during long-term follow-up in patients without HCV eradication, it was found to be significantly lower in patients with persistently normal ALT levels than in those with abnormal ALT levels (P=0.03). Hence, when HCV is not eradicated as a result of IFN therapy, it may induce a long-term carrier state of HCV infection with normal ALT levels in older or male patients, in whom the cumulative incidence of HCC is markedly decreased.