The presence of steatosis and elevation of alanine aminotransferase levels are associated with fibrosis progression in chronic hepatitis C with non-response to interferon therapy
The presence of steatosis and elevation of alanine aminotransferase levels are associated with fibrosis progression in chronic hepatitis C with non-response to interferon therapy
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DOI：
10.1016/j.jhep.2007.12.025
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发表时间：
2008-05-01
影响因子：
25.7
通讯作者：
Izumi, Namiki
中科院分区：
文献类型：
--
作者：
Kurosaki, Masayuki;Matsunaga, Kotaro;Izumi, Namiki
背景/目的：干扰素（IFN）治疗可导致实现持续病毒学应答（SVR）的慢性丙型肝炎患者肝纤维化消退，而未能实现持续病毒学应答的患者的有益效果有限。本研究的目的是确定未达到SVR的患者纤维化进展的相关因素。方法：比较97例治疗失败的慢性丙型肝炎患者IFN前后配对肝活检的纤维化分期评分。活检的平均间隔时间为5.9年。分析与纤维化进展相关的因素。结果：23%的人纤维化进展，47%的人保持不变，29%的人纤维化消退。活检期间脂肪变性和高平均谷丙转氨酶（ALT）是纤维化进展的独立因素，风险比分别为5.53和4.48。两种危险因素均存在的患者的纤维化发病率和年进展率分别为64%和每年0.22 +/- 0.29个纤维化单位，而两种危险因素均不存在的患者的发病率和年进展率分别为8%和每年-0.04 +/- 0.17个纤维化单位。结论：肝脂肪变性和ALT水平升高是慢性丙型肝炎患者纤维化进展的危险因素，这些患者未能达到IFN治疗的SVR，因此可能是阻止潜在进展性疾病的治疗靶点。(C) 2008年欧洲肝脏研究协会。Elsevier B.V.版权所有。
Background/Aims: Interferon (IFN) therapy leads to regression of hepatic fibrosis in chronic hepatitis C patients who achieve a sustained virologic response (SVR), while the beneficial effect is limited in those who fail to do so. The aim of the present study was to define factors associated with progression of fibrosis in patients who do not achieve a SVR.Methods: Fibrosis staging scores were compared between paired liver biopsies before and after IFN in 97 chronic hepatitis C patients who failed therapy. The mean interval between biopsies was 5.9 years. Factors associated with progression of fibrosis were analyzed.Results: Fibrosis progressed in 23%, remained unchanged in 47% and regressed in 29%. Steatosis and a high average alanine aminotransferase (ALT) between biopsies were independent factors for progression of fibrosis with risk ratios of 5.53 and 4.48, respectively. Incidence and yearly rate of progression of fibrosis was 64% and 0.22 +/- 0.29 fibrosis units per year in those with both risk factors compared to 8% and -0.04 +/- 0.17 fibrosis units per year in those negative for both factors.Conclusions: Hepatic steatosis and elevated ALT levels are risk factors for progression of fibrosis in chronic hepatitis C patients who fail to achieve a SVR to IFN therapy and therefore may be therapeutic targets to halt the potentially progressive disease. (C) 2008 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.