title: A case-control histological study on the effects of phlebotomy in patients with chronic hepatitis C.
abstract: OBJECTIVE
  The aim of this study was to assess the actual effectiveness of long-term phlebotomy by comparing histological improvement (HI) in 69 Caucasian HCV-RNA-positive CHC patients undergoing phlebotomy or receiving an interferon-based therapy without virological response [nonresponders to interferon therapy(IBT-NR)].
  
  
  METHODS
  HI was defined by at least one point reduction of the staging score or, in the case of unchanged stage, by at least two points reduction of the grading score (Knodel's Activity Index) and was retrospectively evaluated by comparing two consecutive (56 ± 28 months apart) liver biopsies from 30 phlebotomized and 39 IBT-NR patients.
  
  
  RESULTS
  HI was observed in 15 of 30 (50%) patients treated with phlebotomy and in six of 39 (15%) IBT-NR subjects (P=0.002). Furthermore, AST, ALT, and GGT serum levels were significantly reduced only in phlebotomized patients (P ≤ 0.003) at the time of the second biopsy. Univariate and multivariate analysis showed that histological grading score before therapy (P=0.001) and phlebotomy (P=0.002) were independently predictors of HI.
  
  
  CONCLUSIONS
  HI induced by long-term phlebotomy effectively exceeds that spontaneously occurring in patients IBT-NR confirming the efficacy of iron depletion in attenuating CHC progression when other therapies have failed.
authors: Gastroenterology Unit, AOU Maggiore della Carita', Novara, Italy. sartori@fauser.edu
authors: Massimo
authors: M
authors: Sartori
authors: Silvano
authors: S
authors: Andorno
authors: Angelo
authors: A
authors: Rossini
authors: Renzo
authors: R
authors: Boldorini
authors: Cristina
authors: C
authors: Bozzola
authors: Stefania
authors: S
authors: Carmagnola
authors: Mario
authors: M
authors: Del Piano
authors: Emanuele
authors: E
authors: Albano
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D001706:Biopsy; D016022:Case-Control Studies; D018450:Disease Progression; D005260:Female; D019698:Hepatitis C, Chronic / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007372:Interferons / Q000627:therapeutic use; D008099:Liver / Q000473:pathology; D008297:Male; D008875:Middle Aged; D018962:Phlebotomy; D012720:Severity of Illness Index; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D007372:Interferons