総説

著者

青木　　宏　　森山　光彦　　荒川　泰行
日本大学医学部内科学講座消化器肝臓内科部門

要旨

The hepatitis C virus (HCV) is one of the leading known causes of liver disease worldwide. It is a common cause ofcirrhosis and hepatocellular carcinoma (HCC) as well as the most common reason for liver transplantation. Following theidentification of hepatitis A and hepatitis B, this disorder was categorized in 1974 as “non-A, non-B hepatitis.” In 1989,the hepatitis C virus was identified and found to account for the majority of those patients with non-A, non-B hepatitis. Atpresent, knowledge of hepatitis C has increased dramatically, leading to the need to reexamine the approaches to managementand treatment. Since 1997, several important therapeutic advances have occurred for hepatitis C, particularly withcombination therapy with ribavirin and the introduction of pegylated interferons (PEG-IFN). Combination therapy resultsin better treatment responses than monotherapy, but the highest response rates have been achieved with PEG-IFN incombination with ribavirin. Genotype determinations influence treatment decisions. Currently the best indicator of effectivetreatment is a sustained vilorogical responder (SVR), defined by the absence of detectable HCV-RNA in the serum asshown by a qualitative HCV-RNA assay with lower limit of detection of 50 IU/ml or less at 24 weeks after the end oftreatment. Various studies have suggested that 3 to 20 percent of chronically infected patients will develop cirrhosis overa 20-year period, and these patients are at risk for HCC. It is estimated that HCC occurs after the development of cirrhosisat a rate varying from 0 to 3 percent per year. There is a great need for carefully designed studies on the reliability andbenefit of surveillance screening.

keyword

chronic hepatitis, hepatocellular carcinoma, interferon, RNA virus, vaccine
慢性肝炎，肝癌，インターフェロン，RNAウイルス，ワクチン