Serum globulin levels in predicting the extent of hepatic fibrosis in patients with recurrent post-transplant hepatitis C infection
Serum globulin levels in predicting the extent of hepatic fibrosis in patients with recurrent post-transplant hepatitis C infection
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DOI：
10.1111/j.1399-0012.2007.00657.x
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发表时间：
2007-05-01
影响因子：
2.1
通讯作者：
Ben-Ari, Ziv
中科院分区：
文献类型：
--
作者：
Schmilovitz-Weiss, Hemda;Cohen, Michal;Ben-Ari, Ziv
HCV相关疾病的进展在移植后环境中特别具有侵袭性。复发性HCV感染的受者进行重复的肝活检，以估计疾病进展。在慢性HCV感染的非移植患者中，血清免疫球蛋白水平与肝纤维化之间存在很强的相关性。本研究的目的是确定血清球蛋白和免疫球蛋白水平是否可以预测复发性HCV感染患者的纤维化程度。我们回顾了45例有复发性HCV感染的生化、血清学、病毒学和组织学证据的患者（平均年龄51.6 ± 10.5岁; 53.3%为男性）的记录。中位间隔11.7个月（范围：3-106）后复发; 14例患者（31.1%）的复发感染为重度。平均随访时间为51.4 ± 35.4个月。共进行了96次肝活检。随着活检次数的增加，平均纤维化评分显著增加（p < 0.0001，r = 0.44）。在多变量分析中，严重纤维化的唯一预测因子是血清球蛋白水平（OR：5.97，95% CI：1.82-19.53; p = 0.0004）和IgG水平（OR：1.003，95% CI：1.001-1.006; p = 0.018）。在线性回归分析中，血清球蛋白水平每增加0.5 g/dL，纤维化分期就增加0.22分。总之，血清球蛋白和IgG水平可以作为移植后复发性HCV感染患者肝纤维化程度的非侵入性标志物，从而避免了重复肝活检的需要。这些发现如果得到证实，对预防和治疗该患者组的纤维化具有重要意义。
The progression of HCV-related disease is particularly aggressive in the post-transplantation setting. Recipients with recurrent HCV infection undergo repeated liver biopsies in order to estimate disease progression. A strong association was found between serum immunoglobulins levels and hepatic fibrosis in non-transplanted patients with chronic HCV infection. The aim of this study was to determine if serum globulin and immunoglobulins levels can predict the extent of fibrosis in patients with recurrent HCV infection. The records of 45 patients (mean age 51.6 +/- 10.5 yr; 53.3% men) with biochemical, serologic, virologic, and histological evidence of recurrent HCV infection were reviewed. Recurrence developed after a median interval of 11.7 months (range: 3-106); in 14 patients (31.1%), the recurrent infection was severe. The mean duration of follow-up was 51.4 +/- 35.4 months. A total of 96 liver biopsies were performed. The mean fibrosis score increased significantly with an increase in the number of biopsies (p < 0.0001, r = 0.44). On multivariate analysis, the only predictors of severe fibrosis were serum levels of globulin (OR: 5.97, 95% CI: 1.82-19.53; p = 0.0004) and IgG (OR: 1.003, 95% CI: 1.001-1.006; p = 0.018). On linear regression analysis, for each 0.5-g/dL increase in serum globulin level, there was a 0.22-point increase in fibrosis stage. In conclusion, serum levels of globulin and IgG can serve as a noninvasive marker of the extent of hepatic fibrosis in patients with post-transplant recurrent HCV infection, thus avoiding the need for repeated liver biopsies. These findings, if confirmed, have important implications for the prevention and treatment of fibrosis in this patient group.