Long-term course of interferon-treated chronic hepatitis C
Long-term course of interferon-treated chronic hepatitis C
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DOI：
10.1016/s0168-8278(98)80274-2
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发表时间：
1998-04-01
影响因子：
25.7
通讯作者：
Craxì, A
中科院分区：
文献类型：
--
作者：
Cammà, C;Di Marco, V;Craxì, A
背景/目的：评价α -干扰素的持续应答是否能改善慢性丙型肝炎患者的临床预后。在两项试验中，410名连续患者（65%为慢性肝炎患者，35%为肝硬化患者）接受了α -干扰素治疗（平均随访62.1个月，范围7-109个月），治疗前所有患者血清HCV RNA呈阳性，每周接受3次α -2b或α -n1干扰素治疗，治疗6 - 12个月，持续反应定义为停用干扰素12个月后转氨酶正常。结果：62例（15.1%）；在随访结束时，62名持续缓解者中有56名（90.3%）血清HCV RNA阴性，无论初始组织学、HCV基因型或HCV RNA持续性如何，持续缓解者12个月后未见生化复发。尽管3名患者死于非肝脏原因，但持续缓解者中未观察到肝脏相关事件，34名复发者/无缓解者出现肝脏疾病并发症。9例肝细胞癌，21例腹水，4例门静脉高压性出血，11例复发/无应答者死亡：8例肝脏原因，3例非肝脏原因。持续应答者的无事件生存期明显长于其余所有患者。在回归分析中，对干扰素的持续应答、低年龄和无肝硬化是无事件生存的独立预测因素。结论：对于停止治疗1年以上转氨酶正常且HCV RNA阴性的大多数患者，丙型肝炎病毒可能被根除，肝脏疾病的进展得到预防。
Background/Aims: To evaluate whether sustained response to alpha-interferon improves clinical outcome in patients with chronic hepatitis C.Methods: A cohort of 410 consecutive patients (65% with chronic hepatitis, 35% with cirrhosis) were treated with alpha-interferon in two trials (mean followup 62.1 months, range 7-109 months), All were serum HCV RNA positive before therapy and received first 10 then 5 million units of alpha-2b or alpha-n1 interferon three times weekly for 6 to 12 months, Sustained response was defined as normal aminotransferases 12 months after stopping interferon.Results: Sixty-two patients (15.1%: 54 with chronic hepatitis, eight with cirrhosis) were sustained responders, At the end of follow-up, 56 out of 62 sustained responders (90.3%) were serum HCV RNA negative, No biochemical relapse after 12 months was seen in sustained responders, regardless of initial histology, HCV genotype or persistence of HCV RNA, Although three died of non-hepatic causes, no liver-related events were observed among sustained responders, Complications of liver disease occurred in 34 relapsers/non-responders: nine hepatocellular carcinomas, 21 ascites and four portal hypertensive bleedings, Eleven relapsers/nonresponders died: eight of hepatic and three of non-hepatic causes, Event-free survival was significantly longer in sustained responders than in all the remaining patients, In a regression analysis, sustained response to interferon, low age and absence of cirrhosis were independent predictors of event-free survival.Conclusions: Hepatitis C virus is probably eradicated and progression of liver disease is prevented in most patients who remain HCV RNA negative with normal transaminases for more than 1 year after stopping treatment.