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世界核心医学期刊文摘（胃肠病学分册） 2005年第10期1卷 39-39页

作者： hézode c. Roudot-Thoraval F. Nguyen S. A. Mallat 李翔 Servic. d'hépatologie et de Gastroentér-ologie Centre Hospitalier Universitaire Henri Mondor 51 ave. Marechal Lattre Tassigny 94010 Créteil Cedex France

c.nnabinoids present in c.nnabis sativa (marijuana) exert biologic.l effec.s via c.nnabinoid rec.ptors c.1 and c.2. We rec.ntly demonstrated that c.1 and c.2 rec.ptors regulate progression of experimental liver fibrosis. We therefore investigated the impac. of c.nnabis smoking on fibrosis progression rate in patients with c.ronic.hepatitis c.(c.c.. Two hundred seventy c.nsec.tive untreated patients with c.c.of known duration undergoing liver biopsy were studied. Demographic. epidemiologic.l,metabolic. and virologic.l data were rec.rded, and detailed histories of c.nnabis, alc.hol, and tobac.o use over the span of hepatitis c.virus infec.ion were obtained. Fibrosis stage, steatosis, and ac.ivity grades were sc.red ac.ording to Metavir system. Patientswere c.tegorized as nonc.nnabis users (52.2%), oc.asional users (14.8%), or daily users (33.0%), and the relationship between c.nnabis use and fibrosis progression rate (FPR) or fibrosis stage was assessed. On multivariate analysis, six fac.ors were independently related to a FPR greater than 0.074 (median value of the c.hort): daily c.nnabis use (OR = 3.4 [1.5-7.4]), Metavir ac.ivity grade A2 or higher (OR = 5.4 [2.9-10.3]), age at c.ntamination of more than 40 years (OR = 10.5 [3.0-37.1]), genotype 3 (OR = 3.4 [1.5-7.7]), exc.ssive alc.hol intake (OR = 2.2 [1.1-4.5]), and steatosis (OR = 2.0 [1.0-4.1]). Daily c.nnabis use was also an independent predic.or of a rapid FPR ( >0.15) (OR = 3.6 [1.5-7.5]). Finally, severe fibrosis (≥F3) was also predic.ed by daily c.nnabis use (OR = 2.5 [1.1-5.6]; P = .034), independently of Metavir ac.ivity grade, exc.ssive alc.hol intake, age at liver biopsy, steatosis, and tobac.o smoking. In c.nc.usion, daily c.nnabis smoking is signific.ntly assoc.ated with fibrosis progression during c.c. Patients with ongoing c.c.should be advised to refrain from regular c.nnabis use.

关键词：慢性丙型肝炎肝纤维化肝组织活检脂肪变性详细病史活动程度研究人群进展率人口统计学吸食者

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