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Risk factors for retinopathy associated with interferonα-2b and ribavirin combination therapy in patients with chronic hepatitis C

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World Journal of Gastroenterology 2006年第23期12卷 3756-3759页

作者： Chiaki Okuse Hiroshi Yotsuyanagi Yoshihiko Nagase Yuhtaro Kobayashi Kiyomi Yasuda Kazuhiko Koike shiro iino Michihiro Suzuki Fumio Itoh Division of Gastroenterology and Hepatology Department of Internal Medicine St. Marianna University School of MedicineKawasakiKanagawa 216-8511Japan Department of Infectious Diseases Internal MedicineFaculty of MedicineUniversity of Tokyo7-3-1HongoBunkyoTokyo 113-8655Japan Division of Gastroenterology and Hepatology Department of Internal MedicineSt.Marianna University School of MedicineKawasakiKanagawa 216-8511Japan Center for Liver Diseases Kiyokawa HospitalMinamiasagayaSuginamiTokyo166-0004Japan Department of Infectious Diseases Internal MedicineFaculty of MedicineUniversity of Tokyo7-3-1KongoBunkyoTokyo 113-8655Japan Division of Gastroenterology and Hepatology Department of Internal MedicineSt.Marianna University School of MedicineKawasakiKanagawa216-8511Japan

AIM: To elucidate the frequency and risk factors for retinopathy in patients with chronic hepatitis C who are treated by interferon-ribavirin combination therapy. METHODS: We prospectively analyzed 73 patients with histologically confirmed chronic hepatitis C, who underwent combination therapy for 24 wk. Optic fundi were examined before, and 2, 4, 12 and 24 wk after the start of combination therapy. RESULTS: Fourteen patients (19%) developed retinopathy, which was initially diagnosed by the appearance of a cotton wool spot in 12 patients. Retinal hemorrhage was observed in 5 patients. No patient complained of visual disturbance. Retinopathy disappeared in 9 patients (64%) despite the continuation of combination therapy. However, retinopathy persisted in 5 patients with retinal hemorrhage. A comparison of the clinical background between the groups with and without retinopathy showed no significant differences in age, gender, viral genotype, RNA level, white blood cell count, platelet count, prothrombin time, complications by diabetes mellitus or hypertension, or pretreatment arteriosclerotic changes in the optic fundi. However, multiple logistic regression analysis revealed that complication by hypertension was observed with a high frequency in the group with retinopathy (P = 0.004, OR=245.918, 95% CI=5.6-10786.2). CONCLUSION: Retinopathy associated with combination therapy of interferon a-2b and ribavirin tends to develop in patients with hypertension.

关键词：视网膜病干扰素α-2b 病毒唑丙型病毒肝炎

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Pancreatic involvement in chronic viral hepatitis

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World Journal of Gastroenterology 2005年第23期11卷 3508-3513页

作者： Yoshiki Katakura Hiroshi Yotsuyanagi Kiyoe Hashizume Chiaki Okuse Noriaki Okuse Kohji Nishikawa Michihiro Suzuki shiro iino Fumio Itoh Division of Gastroenterology and Hepatology

AIM: To elucidate the frequency and characteristics of pancreatic disorders in the course of chronic viral hepatitis. METHODS: We prospectively assessed the serum pancreatic enzyme levels and imaging findings in patients with chronic viral hepatitis and healthy control subjects. RESULTS: Serum amylase (t-Amy), salivary amylase (s-Amy), pancreatic amylase (p-Amy) and serum lipase levels were higher in hepatitis patients in comparison to control subjects. However, in asymptomatic viral carriers, only the serum t-Amy levels were higher than those of the controls. The levels of each enzyme rose with the progression of liver disease in patients with hepatitis B or C; whereas the levels of each enzyme within the same clinical stage of the disease did not differ between patients diagnosed with either hepatitis B or hepatitis C virus. Imaging findings demonstrated chronic pancreatitis in only 1 out of 202 patients (0.5%).CONCLUSION: Our data suggest that serum levels of pancreatic enzymes increase with the progression of liver disease in patients diagnosed with viral hepatitis. Pancreatic disease, asymptomatic in most cases, may represent an extrahepatic manifestation of chronic viral hepatitis.

关键词：慢性病毒肝炎胰腺损伤病理机制临床表现

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Fatal liver failure caused by reactivation of lamivudine-resistant hepatitis B virus:A case report

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World Journal of Gastroenterology 2007年第6期13卷 964-969页

作者： Yuka Suzuki Hiroshi Yotsuyanagi Chiaki Okuse Yoshihiko Nagase Hideaki Takahashi Kyoji Moriya Michihiro Suzuki Kazuhiko Koike shiro iino Fumio Itoh Division of Gastroenterology and Hepatology Department of Internal Medicine St. Marianna University School of Medicine 2-16-1 Sugao Miyamae-ku Kawasaki 216-8511 Japan Division of Infectious Diseases Department of Internal Medicine University of Tokyo 7-3-1 Hongo Bunkyo-ku Tokyo 113-0033 Japan Center for Liver Diseases Seizankai Kiyokawa Hospital 2-31-12 Asagayaminami Suginami Tokyo 166-0004 Japan

We present a case of fetal liver failure caused by the activation of lamivudine-resistant hepatitis B virus (HBV) nine months after lamivudine treatment. A 57-year old man visited our hospital for the treatment of decompensated chronic hepatitis B. Lamivudine was started in December 2001. Subsequently, serum HBV was negative for HBV DNA with seroconversion from HBeAg to anti-HBe and improvement of liver function. However, HBV DNA and HBeAg were again detected in September 2002. He was complicated by breakthrough hepatitis and admitted to our hospital in November for severely impaired liver function. Vidarabine treatment was started and serum HBV DNA and alanine aminotransferase (ALT) decreased transiently. However, after the start of α-interferon treatment, HBV DNA level increased and liver function deteriorated. He died 1 mo after admission. An analysis of amino acid sequences in the polymerase region revealed that rtM204I/V with rtL80I/V occurred at the time of viral breakthrough. After the start of antiviral treatment, rtL180M was detected in addition to rtM204I/V and rtL80I/V, and became predominant in the terminal stage of the disease. HBV clone with a high replication capacity may be produced by antiviral treatment leading to the worsening of liver function. Antiviral therapy for patients with breakthrough hepatitis in advanced liver disease should be carefully performed.

关键词：乙型肝炎病毒拉米夫定耐药病毒再活化肝衰竭病例报告

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成年志愿者接种冻干甲型肝炎疫苗的临床观察

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微生物学免疫学进展 1992年第3期20卷 32-34页

作者： shiro iino 董保科

甲肝在世界大部分地区是常见病,即使在发达国家甲肝仍然是一个严重的问题。当前在日本30岁以下的年怪人,仅1.5％甲肝抗体阳性。年平均约有10万人感染甲肝,20-40岁发病率最高。注射丙种球蛋白只能对甲肝具高危的年轻人作特异性预防,免疫... 详细信息

甲肝在世界大部分地区是常见病,即使在发达国家甲肝仍然是一个严重的问题。当前在日本30岁以下的年怪人,仅1.5％甲肝抗体阳性。年平均约有10万人感染甲肝,20-40岁发病率最高。注射丙种球蛋白只能对甲肝具高危的年轻人作特异性预防,免疫力只能维持4-6个月,而注射甲肝疫苗预期更有效和持久。

关键词：甲型肝炎甲型肝炎疫苗免疫接种临床观察

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