Patients with Chronic Hepatitis C May be More Sensitive to Iron Hepatotoxicity than Patients with HFE-Hemochromatosis
Patients with Chronic Hepatitis C May be More Sensitive to Iron Hepatotoxicity than Patients with HFE-Hemochromatosis
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DOI：
10.2169/internalmedicine.49.4088
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发表时间：
2010-01-01
影响因子：
1.2
通讯作者：
Goto, Hidemi
中科院分区：
文献类型：
--
作者：
Hayashi, Hisao;Piperno, Alberto;Goto, Hidemi
目的在慢性丙型肝炎中，铁可能作为肝毒性的辅助因子发挥重要作用。因此，静脉注射，血色病的标准治疗方法，已被提出作为一种替代方案的患者谁响应较差的抗病毒治疗。为了提高我们对铁引起的肝毒性的理解，我们比较了慢性丙型肝炎患者和HFE-血色素沉着症患者对静脉注射的反应。方法14例日本慢性丙型肝炎患者和8例意大利HFE-血色素沉着症患者进行了反复静脉注射，血清铁蛋白终点分别为20和50 ng/mL。血清铁指标和肝功能检查在治疗前和治疗后的血液样品从每个病人。结果肝炎和血色素沉着症患者经放血治疗后，血清铁蛋白、转氨酶和铁调素25均降低。血清转氨酶活性，而不是血清铁蛋白水平，是预测有效的铁去除治疗。在血色病患者中，铁调素调节被设定在不适当的低水平（11.1 +/- 9.2 ng/mL），但在肝炎患者中并非如此（30.7 +/- 14.5 ng/mL）。因此，血色病患者的估计体内铁储存量为5，960 +/-2，750 mg，而肝炎患者为730 +/- 560 mg。从肝酶还原率判断，肝炎患者似乎更敏感的铁肝毒性比血色素沉着症patients.Conclusion铁肝毒性的阈值和利益，其去除慢性丙型肝炎患者和HFE血色素沉着症患者之间的差异，刺络是一个有效的治疗选择，以减少肝脏疾病的活动在这两种疾病。
Aim In chronic hepatitis C, iron might play an important role as a hepatotoxic co-factor. Therefore, venesection, a standard treatment for hemochromatosis, has been proposed as an alternative for patients who respond poorly to anti-viral therapy. To improve our understanding of iron-induced hepatotoxicity, we compared the responses to venesection between patients with chronic hepatitis C and those with HFE-hemochromatosis.Methods Fourteen Japanese patients with chronic hepatitis C and eight Italian patients with HFE-hemochromatosis underwent repeated venesection with a serum ferritin endpoint of 20 and 50 ng/mL, respectively. Serum iron indices and liver function tests were measured in pre- and post treatment blood samples from each patient. Body iron stores were calculated using the removed blood volume.Results In both patients with hepatitis and hemochromatosis, serum ferritin, aminotransferase and hepcidin 25 were reduced after venesection. The serum aminotransferase activity, but not the serum ferritin level, was predictive of effective iron removal treatment. Hepcidin regulation was set at an inappropriately low level in hemochromatosis patients (11.1 +/- 9.2 ng/mL), but not so in hepatitis patients (30.7 +/- 14.5 ng/mL). Inversely, the estimated body iron stores of hemochromatosis patients were 5,960 +/- 2,750 mg, while those of hepatitis patients were 730 +/- 560 mg. Judging from the liver enzyme reduction ratio, patients with hepatitis seemed to be more sensitive to iron hepatotoxicity than hemochromatosis patients.Conclusion Even though the threshold of iron hepatotoxicity and benefit of its removal differ between patients with chronic hepatitis C and those with HFE-hemochromatosis, venesection is a valid choice of treatment to reduce liver disease activity in both diseases.