title: Long term effects of phlebotomy on biochemical and histological parameters of chronic hepatitis C.
abstract: OBJECTIVE
  There is considerable evidence that iron is a risk factor for liver injury in chronic hepatitis C. Known as iron reduction therapy, phlebotomy reduces serum ALT activity. This effect might continue with maintenance phlebotomy and result in slower progression of liver fibrosis.
  
  
  METHODS
  We examined the biochemical parameters and liver histology of patients with chronic hepatitis C treated by maintenance phlebotomy. For biochemical evaluation, 25 patients were treated by initial phlebotomy to reduce serum ferritin levels to 10 ng/ml or less and then observed for 5 yr with maintenance phlebotomy to maintain the iron-deficient state. For histological evaluation, liver biopsies were performed before and after the study period in 13 of the patients. Thirteen patients who were virological nonresponders to interferon alone and had undergone second liver biopsies after more than 3 yr served as histological controls.
  
  
  RESULTS
  Serum aminotransferase levels were decreased significantly by initial phlebotomy and remained at the same levels during the study period (p < 0.05). The grading scores were improved significantly in the study group (p < 0.05) and unchanged in the controls. The staging scores remained unchanged in the study group but were increased in the controls (p < 0.005). Disease progression was significantly different between the two groups (p < 0.05).
  
  
  CONCLUSIONS
  These results suggest that phlebotomy with maintenance lowers serum aminotransferase levels, improves liver inflammation, and suppresses the progression of liver fibrosis in chronic hepatitis C.
authors.affiliation: Third Department of Internal Medicine, Nagoya University School of Medicine, Japan.
authors.forename: Motoyoshi
authors.initials: M
authors.lastname: Yano
authors.forename: Hisao
authors.initials: H
authors.lastname: Hayashi
authors.forename: Shinya
authors.initials: S
authors.lastname: Wakusawa
authors.forename: Fujiko
authors.initials: F
authors.lastname: Sanae
authors.forename: Toshikuni
authors.initials: T
authors.lastname: Takikawa
authors.forename: Yuhta
authors.initials: Y
authors.lastname: Shiono
authors.forename: Motohiro
authors.initials: M
authors.lastname: Arao
authors.forename: Koji
authors.initials: K
authors.lastname: Ukai
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ito
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Watanabe
authors.forename: Kentaro
authors.initials: K
authors.lastname: Yoshioka
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D005260:Female; D005500:Follow-Up Studies; D019698:Hepatitis C, Chronic / Q000473:pathology* / Q000628:therapy*; D006801:Humans; D007150:Immunohistochemistry; D019190:Iron Overload / Q000175:diagnosis* / Q000628:therapy*; D008103:Liver Cirrhosis / Q000517:prevention & control*; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D018962:Phlebotomy / Q000379:methods*; D011336:Probability; D012016:Reference Values; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016896:Treatment Outcome