Efficacy and safety of addition of minor bloodletting (petit phlebotomy) in hepatitis C virus-infected patients receiving regular glycyrrhizin injections.
BACKGROUND
Hepatoprotective therapies that include regular glycyrrhizin injections (GIs) are beneficial for chronic hepatitis C patients, but are sometimes insufficient for normalizing serum alanine aminotransferase (ALT) levels. Here, we evaluated whether the addition of minor bloodletting, named petit phlebotomy (PP), prior to each GI could further reduce serum ALT concentrations in such patients.


METHODS
Seventy-six hepatitis C virus (HCV)-infected patients receiving regular GI, with persistently abnormal serum ALT levels, were randomly divided into GI + PP and GI groups and monitored for 12 months. PP was performed before every GI to a total 60 ml of blood a week. The primary PP endpoint was a serum ferritin level of less than 20 ng/ml. PP was suspended upon reaching the endpoint, but was resumed as needed. The efficacy of the addition of PP was evaluated by measuring changes in serum ALT levels.


RESULTS
Two patients in each group dropped out because of the appearance of hepatocellular carcinoma. The remainder completed the 12-month treatment with no serious adverse events. Serum ALT and ferritin levels were significantly decreased in the GI + PP group (from 67 +/- 34 to 44 +/- 14 U/l and from 163 +/- 127 to 25 +/- 21 ng/ml, respectively, both P < 0.001), but these changes were not seen in the GI group. Although 20 patients in the GI + PP group had compensated cirrhosis, no significant reductions in serum albumin concentrations were observed.


CONCLUSIONS
The addition of PP is effective and safe for improving serum aminotransferase levels in HCV-infected patients receiving regular GI, even in those with compensated cirrhosis.
Department of Metabolic Regulation, Shinshu University Graduate School of Medicine, Asahi 3-1-1, Matsumoto 390-8621, Japan. naopi@shinshu-u.ac.jp
Naoki
N
Tanaka
Akira
A
Horiuchi
Takahiro
T
Yamaura
Michiharu
M
Komatsu
Takahide
T
Yokoyama
Shinji
S
Okaniwa
Tadanobu
T
Nagaya
Kaname
K
Yoshizawa
Kendo
K
Kiyosawa
Toshifumi
T
Aoyama
Eiji
E
Tanaka
D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D001815:Bloodletting / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D005293:Ferritins / Q000097:blood; D019695:Glycyrrhizic Acid / Q000008:administration & dosage*; D019698:Hepatitis C, Chronic / Q000097:blood / Q000517:prevention & control / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D019695:Glycyrrhizic Acid; D005293:Ferritins; D000410:Alanine Transaminase