RESUMEN
AIM: To investigate the occurrence and severity of pruritus in chronic hepatitis C patients treated with or without interferon (IFN) therapy. METHODS: A total of 89 patients with chronic hepatitis C and 55 control (non-hepatitis) patients were asked to rate their experience of diurnal and nocturnal pruritus in the preceding week using a visual analogue scale (VAS) and a five-point scale, respectively. Blood samples were taken and serum thymus and activation-regulated chemokine (TARC) levels were measured by enzyme-linked immunosorbent assay. RESULTS: A significantly greater proportion of chronic hepatitis C patients experienced nocturnal pruritus compared with control (58.4% vs 5.5%, P < 0.0001). Chronic hepatitis C patients also had more severe pruritus compared with control patients, indicated by the higher mean VAS scores in both the IFN-treated and non-IFN-treated groups. In particular, patients who received combined peginterferon alfa-2b and ribavirin had significantly higher mean VAS scores than those receiving peginterferon alfa-2a or no IFN treatment. Serum TARC levels did not correlate with pruritus scores, and no significant differences in TARC levels were observed between the IFN-treated and non-IFN-treated groups. CONCLUSION: Patients with chronic hepatitis C experience pruritus more than those without. Serum TARC levels do not correlate with pruritus severity in chronic hepatitis C patients.
Asunto(s)
Hepatitis C Crónica/complicaciones , Prurito/etiología , Adulto , Anciano , Antivirales/uso terapéutico , Biomarcadores/sangre , Estudios de Casos y Controles , Quimiocina CCL17/sangre , Quimioterapia Combinada , Ensayo de Inmunoadsorción Enzimática , Femenino , Hepatitis C Crónica/diagnóstico , Hepatitis C Crónica/tratamiento farmacológico , Humanos , Interferón alfa-2 , Interferón-alfa/uso terapéutico , Masculino , Persona de Mediana Edad , Polietilenglicoles/uso terapéutico , Valor Predictivo de las Pruebas , Prurito/sangre , Prurito/diagnóstico , Proteínas Recombinantes/uso terapéutico , Ribavirina/uso terapéutico , Factores de Riesgo , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND/AIMS: Hepatocellular carcinoma occurs frequently in cirrhosis related to hepatitis C virus (type C cirrhosis), and preventative treatment with interferon is costly and likely to cause adverse reactions. Menatetrenone, a vitamin K2 preparation, has recently been reported to inhibit the posttreatment relapse of hepatocellular carcinoma. We therefore examined whether menatetrenone could prevent the development of hepatocellular carcinoma in patients with type C cirrhosis. METHODOLOGY: This prospective, randomized trial recruited patients with type C cirrhosis, platelet count of 10 x 10(4) microl or less, and no history of hepatocellular carcinoma. Patients were assigned to a menatetrenone group (n = 22, 4 5mg of menatetrenone daily, orally) or a control group (n = 18). Follow-up with image diagnosis was performed every 3-6 months. RESULTS: No adverse events of menatetrenone treatment were observed. Hepatocellular carcinoma occurred in 2 of 22 patients in the menatetrenone group (9.1%) and 5 of 18 patients in the control group (27.8%); however, this difference did not reach statistical significance. CONCLUSIONS: The present findings suggest that menatetrenone has some inhibitory effect on development of hepatocellular carcinoma in patients with type C cirrhosis. Consequently, to further validate its benefits, we believe that menatetrenone should be actively administered to patients with intractable (interferon-resistant) cirrhosis.
Asunto(s)
Anticarcinógenos/uso terapéutico , Carcinoma Hepatocelular/prevención & control , Cirrosis Hepática/complicaciones , Neoplasias Hepáticas/prevención & control , Vitamina K 2/análogos & derivados , Vitamina K 2/uso terapéutico , Anciano , Carcinoma Hepatocelular/etiología , Femenino , Humanos , Neoplasias Hepáticas/etiología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Vitamina K 2/efectos adversosAsunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , ADN Viral/genética , Virus de la Hepatitis B/genética , Hepatitis B/etiología , Linfoma de Células B/tratamiento farmacológico , Linfoma de Células B Grandes Difuso/tratamiento farmacológico , Anticuerpos Monoclonales/uso terapéutico , Anticuerpos Monoclonales de Origen Murino , Antineoplásicos/uso terapéutico , Ciclofosfamida/uso terapéutico , ADN Viral/sangre , Doxorrubicina/uso terapéutico , Hepatitis B/sangre , Hepatitis B/genética , Virus de la Hepatitis B/metabolismo , Humanos , Linfoma de Células B/sangre , Linfoma de Células B/complicaciones , Linfoma de Células B Grandes Difuso/sangre , Linfoma de Células B Grandes Difuso/complicaciones , Masculino , Persona de Mediana Edad , Prednisona/uso terapéutico , Rituximab , Vincristina/uso terapéuticoRESUMEN
A sensitive method for measuring the serum level of protein-induced by vitamin K absence or antagonist II (PIVKA-II) has become so widely available that it is now used for the clinical diagnosis of small hepatocellular carcinoma (HCC). It is known that serum PIVKA-II can be a prognostic indicator for HCC, but there have been no detailed investigations concerning the tissue expression of PIVKA-II. The present study assessed the relationship between serum or tissue PIVKA-II and the biological malignant potential of HCC. The subjects were 25 patients with histologically confirmed HCC, that were solitary and 3 cm or less in diameter. Tissue PIVKA-II was detected by immunostaining using MU-3 as the primary antibody. The biological malignant potential of the tumors was evaluated on the basis of the Ki-67 labeling index of HCC cells and the tumor arterial vascularity assesed by angiography and CO(2) enhanced ultrasonography. The recurrence-free period after treatment was also evaluated. Among the 25 patients, eight were positive for tissue PIVKA-II. Serum PIVKA-II levels were significantly higher in the tissue PIVKA-II-positive patients compared with the negative patients, but serum and tissue PIVKA-II expressions were not consistently parallel. Tumor cell proliferation was closely correlated with the tissue PIVKA-II expression, while the recurrence-free period was correlated with the serum PIVKA-II level. Tumor arterial vascularity showed a strong correlation with the expression of both serum and tissue PIVKA-II. In conclusion, serum and tissue PIVKA-II expression reflect the biological malignant potential of HCC and thus may be useful indicators for the prognosis of small HCC.