Long term effects of phlebotomy on biochemical and histological parameters of chronic hepatitis C.
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.
Yano
Motoyoshi
M
Third Department of Internal Medicine, Nagoya University School of Medicine, Japan.
Hayashi
Hisao
H
Wakusawa
Shinya
S
Sanae
Fujiko
F
Takikawa
Toshikuni
T
Shiono
Yuhta
Y
Arao
Motohiro
M
Ukai
Koji
K
Ito
Hiroshi
H
Watanabe
Kazumasa
K
Yoshioka
Kentaro
K
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