Iori Goto

Long-term outcome, with monitoring of platelet counts, in patients with chronic hepatitis C and liver cirrhosis after interferon therapy

Objective: Because the determination of the stage of fibrosis depends on rather subjective judgment, more objective parameters are needed. In this study, we followed the long-term outcome, with monitoring of platelet counts, in patients with chronic hepatitis C or liver cirrhosis (LC) who had undergone interferon (IFN) therapy. Methods: 596 patients who were diagnosed at our institute from 1987 to 1998 with chronic hepatitis C and LC were treated with IFNs. A further 58 patients were not treated (NT). The annual rate of changes in platelet counts were calculated and compared for IFN-treated and NT patients. Results: The relationship between the efficacy of IFN therapy and the incidence of hepatocellular carcinoma (HCC) showed that the patients who were virologic sustained responders (VSR) had a significantly lower incidence of HCC than the nonresponders (NR) and NT patients. The change in platelet counts was +4,350/µl/year in the VSR, +1,010/µl/year in the biochemical sustained responders (BSR), –4,540/µl/year in the NR and –6,180/µl/year in the NT patients, indicating a significant platelet increase in the VSR, a decrease of the same magnitude in the NR and NT patients, and no change in the BSR. The cumulative probability of developing HCC and liver failure was significantly higher in groups with decreased platelet counts than in groups with increased platelet counts among patients who had undergone IFN therapy. Multivariate analyses revealed that a decrease in platelet counts was the cardinal risk factor for development of HCC and liver failure in chronic hepatitis C or LC patients. Conclusion: Investigation of platelet counts was useful for determining the long-term outcome of patients who had undergone IFN therapy and for predicting the development of HCC.

Decreased risk of hepatocellular carcinoma in patients with chronic hepatitis C whose serum alanine aminotransferase levels became less than twice the upper limit of normal following interferon therapy

Abstract: Aim: The incidence of hepatocellular carcinoma (HCC) in C‐viral chronic hepatitis (CH) and liver cirrhosis (LC) patients after interferon (IFN) therapy was evaluated according to alanine aminotransferase (ALT) levels.

Patients with severe liver cirrhosis followed up by L-[1-13C] phenylalanine breath test

Compared to healthy subjects, patients with severe liver cirrhosis (LC) are reported to show lower values in the L-[1-13C] phenylalanine breath test (PBT). We performed this test several times during the clinical course in two patients with severe liver cirrhosis (LC). Patient 1 was a 67-year-old woman with non-B, non-C LC and hepatocellular carcinoma (HCC) in the lateral hepatic segment. Because the patient wanted to receive nonsurgical treatment for HCC, intraarterial administration of zinostatin stimalamer was performed. The patient was hospitalized four times before her death from liver failure on December 20, 2000. During her clinical course, PBT was performed four times. Values for both the rate of hepatic phenylalanine oxidation (%13C dose h−1) and %13C cumulative excretion gradually decreased during her clinical course. Patient 2 was a 57-year-old man with hepatitis C virus (HCV)-positive LC. He was hospitalized seven times between December 1998 and his death on May 24, 2001. During his clinical course, PBT was performed four times. Values for both %13C dose h−1 and %13C cumulative excretion decreased during his clinical course. We confirmed that PBT was useful for following the course of LC.

The clinical significance of GBV-C/HGV exposure in C-viral chronic liver disease and blood donors

Aims: The relationship between the hepatitis G virus (HGV) RNA-positive state or the HGV anti-E2 antibody-positive state, and various clinical parameters among patients with C-viral chronic liver disease and blood donors, was examined. Patients and methods: The subjects consisted of 166 patients with hepatitis C virus (HCV) RNA-positive liver disease, and 157 blood donors. Serum samples were tested for the presence of HGV RNA by the polymerase chain reaction method. The HGV E2 antibody level was measured with an enzyme-linked immunosorbent assay kit. Results: HGV RNA was detected in 1.3% of the blood donors, and HGV E2 antibodies were detected in the sera of 2.5% of the blood donors. The detection rate of HGV RNA and HGV E2 antibodies among the patients with C-viral liver disease was 4.8 and 28.3%, respectively. The detection rates of HGV RNA and HGV E2 antibody among those in each F stage were 0 and 25.0% among those in the F1 stage, 2.6 and 34.2% among those in F2, 11.1 and 27.8% among those in F3, 12.5 and 29.2% among those in F4, and 11.1 and 27.8% among those with hepatocellular carcinoma (HCC). The detection rate of HGV RNA increased with the progression of the F stage and HCC, however, the detection rate of HGV E2 antibody among the four F stages and HCC did not significantly differ. In addition, the clinical parameters and background of those who did or did not have HGV E2 antibodies or HGV RNA, did not significantly differ. Conclusion: HGV exposure may promote the progression of liver fibrosis (F stage) in C-viral liver diseases.