Histologic improvement of fibrosis in patients with hepatitis C who have sustained response to interferon therapy
Histologic improvement of fibrosis in patients with hepatitis C who have sustained response to interferon therapy
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DOI：
10.7326/0003-4819-132-7-200004040-00002
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发表时间：
2000-04-04
影响因子：
39.2
通讯作者：
Omata, M
中科院分区：
文献类型：
--
作者：
Shiratori, Y;Imazeki, F;Omata, M
背景：在随访超过2年的研究中，丙型肝炎相关肝纤维化的短期组织学改善已被注意到，但干扰素治疗对肝纤维化的长期影响尚不清楚。目的：评价慢性丙型肝炎患者干扰素治疗后肝纤维化的变化。设计：回顾性队列研究。环境：日本7所大学医院和1所国立医院。患者：1987年至1997年593例慢性丙型肝炎患者接受配对肝活检。其中，487名患者接受了干扰素治疗，106名患者未接受治疗。干预：治疗组患者在首次活检后6个月内接受2- 6个月的干扰素疗程。测量：配对活检样本中间隔中位数为3.7年（范围1至10年）的纤维化和炎症活动分别采用Desmet及其同事的标准（F0至F4）和法国METAVIR合作研究组的标准（A0至A3）进行分级。计算纤维化分期和活动度评分的变化以及纤维化进展和消退的年率。结果：487例干扰素治疗患者中有183例出现持续的病毒学应答。在大多数未经治疗的患者中，活性等级没有变化，在持续病毒学应答的患者中，89% （CI, 83% - 93%）的活性等级得到改善。对干扰素的持续反应与纤维化评分的平均（ISE）降低相关，在随访不到3年时为-0.60 +/- 0.07，在随访3年或更长时间时为-0.88 +/- 0.08。持续缓解患者的纤维化进展率为-0.28 +/- 0.03单位/y（回归），非持续缓解患者的纤维化进展率为0.02 +/- 0.02单位/y (P < 0.001)，未治疗患者的纤维化进展率为0.10 +/- 0.02单位/y。结论：虽然活检间隔时间部分影响患者的临床病程，但本文观察到的差异表明，在慢性丙型肝炎患者中，纤维化的消退与干扰素治疗的持续病毒学反应有关。
Background: Short-term histologic improvement in hepatitis C-related hepatic fibrosis has been noted in studies with more than 2 years of follow-up, but the long-term effects of interferon therapy on hepatic fibrosis remain unclear.Objective: To assess changes in hepatic fibrosis after interferon therapy in patients with chronic hepatitis C.Design: Retrospective cohort study.Setting: 7 university hospitals and 1 national hospital in Japan.Patients: 593 patients with chronic hepatitis C who underwent a paired liver biopsy from 1987 to 1997. Of these, 487 patients received interferon therapy and 106 patients were untreated.Intervention: Patients in the treatment group received a 2- to 6-month course of interferon within 6 months after the initial biopsy.Measurements: Fibrosis and inflammatory activity in paired biopsy samples obtained a median of 3.7 years apart (range, 1 to 10 years) were graded by using the criteria of Desmet and colleagues (F0 to F4) and those of the French METAVIR Cooperative Study Group (A0 to A3), respectively. Changes in fibrosis staging and activity scores and yearly rates of fibrosis progression and regression were calculated.Results: 183 of the 487 interferon-treated patients showed a sustained virologic response. Activity grade was unchanged in most of the untreated patients and improved in 89% (CI, 83% to 93%) of patients with a sustained virologic response. A sustained response to interferon was associated with a mean (ISE) reduction in fibrosis score of -0.60 +/- 0.07 at less than 3 years of follow-up and -0.88 +/- 0.08 at 3 years or more of follow-up. The rate of fibrosis progression was -0.28 +/- 0.03 unit/y (regression) in patients with sustained response, 0.02 +/- 0.02 unit/y in patients with nonsustained response (P < 0.001), and 0.10 +/- 0.02 unit/y in untreated patients.Conclusion: Although the time between biopsies partly affected the patient's clinical course, the differences observed here suggest that in patients with chronic hepatitis C, regression of fibrosis is associated with sustained virologic response to interferon therapy.