| 特集名 | 急性肝障害―薬物性肝障害とウイルス肝炎 | |
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| 題名 | 急性肝障害を起こす疾患 (2) ウイルス性急性肝障害とその治療 c．C型肝炎 | |
| 発刊年月 | 2010年 10月 | |
| 著者 | 田中 榮司 | 信州大学医学部附属病院消化器内科 |
| 【 要旨 】 | C型急性肝炎は比較的肝障害の程度は軽く，劇症化はまれである．しかし，慢性化率が高く，いったん慢性化すると長年の経過で肝硬変に進展し，肝細胞癌を合併する． 急性肝炎の診断ではHCV抗体は遅れて陽性になる傾向があり，これが陰性でもC型肝炎は否定できない．この場合，HCV RNAまたはHCVコア抗原を測定し，ウイルス血症の有無を確認する．慢性化予防にはIFN治療が有用である．genotype1型では発症後8 週目までの，またgenotype2型と3 型では20 週目までの，genotype 4型では12週目までの開始が望ましい．リバビリンの併用効果は少ないとされている．治療期間は，genotype 1型では24週，genotype 2～4型では8～12週の期間が必要である． |
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| Theme | Acute Liver Injury ： Drug-induced and Viral Liver Injuries | |
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| Title | Diagnosis and Treatment of Acute Hepatitis C | |
| Author | Eiji Tanaka | Department of Medicine (Gastroenterology), Shinshu University Hospital |
| [ Summary ] | Patients with acute hepatitis C rarely develop fulminant hepatitis, but usually develop chronic hepatitis. Once chronic hepatitis is established, fibrosis of the liver progress gradually. Patients with chronic hepatitis C are known to be at risk for developing cirrhosis and hepatocellular carcinoma during the long term clinical course of this condition. Hepatitis C virus (HCV) antibody assays can detect the vast majority of patients with persistent HCV infection. However, the assay method is not useful for early diagnosis of acute hepatitis C because the appearance of antibodies is often delayed. For that reason, detection of HCV RNA or HCV core antigens is required. Interferon therapy before the development of chronic hepatitis is quite useful in preventing chronicity. The therapy should be started within 8 weeks after the onset of acute hepatitis C in patients with genotype 1 HCV infection. A total of 24 weeks interferon administration is recommended for these patients. Simultaneous use of ribavirin is not essential. In patients with genotype 2 or 3 HCV infection, it is recommended that interferon therapy be started within 20 weeks of onset and continue for 8 to 12 weeks. |
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