Long-term phlebotomy with low-iron diet therapy lowers risk of development of hepatocellular carcinoma from chronic hepatitis C
Long-term phlebotomy with low-iron diet therapy lowers risk of development of hepatocellular carcinoma from chronic hepatitis C
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DOI：
10.1007/s00535-007-2095-z
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发表时间：
2007-10-01
影响因子：
6.3
通讯作者：
Niitsu, Yoshiro
中科院分区：
文献类型：
--
作者：
Kato, Junji;Miyanishi, Koji;Niitsu, Yoshiro
背景我们先前已经证明，在慢性丙型肝炎（CHC）患者中，铁缺乏可改善血清丙氨酸氨基转移酶（ALT）水平以及肝脏氧化DNA损伤。然而，它还没有确定是否持续缺铁治疗CHC有利地影响其进展为肝细胞癌（HCC）。我们对经活检证实的中度或重度肝纤维化的CHC患者进行了一项队列研究，这些患者对既往干扰素（IFN）治疗无效或存在干扰素治疗无效的情况。将患者分为两组：A组（n = 35）每周进行静脉切开（200 g），直至达到轻度缺铁状态，随后每月进行静脉切开，持续44-144个月（中位数，107个月），并建议他们食用低铁饮食B组（n = 40）为拒绝接受铁耗竭治疗的CHC患者。在A组中，在维持阶段，所有患者的血清ALT水平均降至60 IU/l以下，24例患者（69%）恢复正常（< 40 IU/l），而在B组中，未发生血清ALT自发性降低。A、B组第5年末肝癌发生率分别为5.7%和17.5%，第10年末分别为8.6%和39%。多因素分析显示，与未经治疗的患者相比，缺铁治疗显著降低了HCC的风险（优势比，0.57）（P = 0.0337）。CHC患者的长期铁缺乏是降低进展为HCC的风险的有希望的方式。
Background. We have previously demonstrated that in patients with chronic hepatitis C (CHC), iron depletion improves serum alanine aminotransferase (ALT) levels as well as hepatic oxidative DNA damage. However, it has not been determined whether continuation of iron depletion therapy for CHC favorably influences its progression to hepatocellular carcinoma (HCC).Methods. We conducted a cohort study on biopsy-proven CHC patients with moderate or severe liver fibrosis who failed to respond to previous interferon (IFN) therapy or had conditions for which IFN is contradicted. Patients were divided into two groups: subjects in group A (n = 35) underwent weekly phlebotomy (200 g) until they reached a state of mild iron deficiency, followed by monthly maintenance phlebotomy for 44-144 months (median, 107 months), and they were advised to consume a low-iron diet (5-7 mg iron/day); group B (n = 40) comprised CHC patients who declined to receive iron depletion therapy.Results. In group A, during the maintenance phase, serum ALT levels decreased to less than 60 IU/l in all patients and normalized (< 40 IU/l) in 24 patients (69%), whereas in group B no spontaneous decrease in serum ALT occurred. Hepatocarcinogenesis rates in groups A and B were 5.7% and 17.5% at the end of the fifth year, and 8.6% and 39% in the tenth year, respectively. Multivariate analysis revealed that iron depletion therapy significantly lowered the risk of HCC (odds ratio, 0.57) compared with that of untreated patients (P = 0.0337).Conclusions. Long-term iron depletion for CHC patients is a promising modality for lowering the risk of progression to HCC.