每天喝咖啡与降低慢性C型肝炎恶化风险有关


  【24drs.com】November 2, 2009 — 根据在线登载于10月20日Hepatology期刊的一篇大型前瞻性研究结果,每天喝3杯以上咖啡与降低慢性C型肝炎恶化风险有关。
  
  第一作者、国家癌症研究中心的Neal Freedman博士在新闻稿中表示,这是首次描述与C型肝炎有关的肝病恶化和喝咖啡之关联的研究。因为有许多人感染C型肝炎病毒(HCV [hepatitis C virus]),因此确认与肝病恶化相关的可调整风险因素很重要。虽然我们无法排除喝咖啡之外的其它因素的可能性,但我们的研究结果认为,喝较多咖啡的病患,其疾病恶化风险较低。
  
  研究样本包括「Hepatitis C Antiviral Long-Term Treatment against Cirrhosis (HALT-C)」试验的766名研究对象,肝脏切片有C型肝炎相关桥状纤维化或肝硬化,且peginterferon加ribavirin治疗无法达到病毒持续性反应。
  
  在3.8年的追踪期间,每三个月评估一次临床结果,包括腹水、慢性肝病恶化、肝脏相关死亡率、肝性脑病变、肝细胞肿瘤、自发性细菌性腹膜炎、静脉曲张出血或肝纤维化增加。没有肝硬化的研究对象中,还有一个结果,在第1.5和3.5年进行的预定切片中,Ishak肝脏纤维化指数增加2分。
  
  开始时,喝较多咖啡与切片较少严重脂肪变性、白蛋白值较高、血清AST/ALT比值较低、α-胎儿蛋白值较低、胰岛素值较低、以及体内平衡模型评估等有关(各项比较之P < .05)。
  
  在230名病患中,与增加咖啡摄取量而降低相关比率的结果为:每100人-年中,11.1人完全没喝、12.1人每天喝不到1杯、8.2人每天喝1-3杯、6.3人每天喝3杯以上(趋势P值 = .0011)。相较于未喝咖啡者的对应相对风险为,喝不到1杯者为1.11 (95%信赖区间[CI]为0.76 - 1.61)、喝1-3杯者为0.70 (95% CI为0.48 - 1.02)、喝3杯以上者为0.47 (95% CI为0.27 - 0.85) (趋势P值 = .0003)。
  
  开始时的指定治疗方式或肝硬化状态并不会影响风险评估,饮用较多绿茶或红茶与结果无关。
  
  研究限制包括观察性研究设计;无法一般化到健康族群;采用自我报告的资料;缺乏有关无咖啡因咖啡、汽水与咖啡酿煮方式的资料。
  
  研究作者写道,在一个末期C型肝炎相关肝病患者的大型前瞻性研究中,规律饮用咖啡与疾病恶化率较低有关。本研究观察到的咖啡与肝病恶化之间的关联,与饮酒和抽菸无关。
  
  国家糖尿病与消化道与肾病研究中心、国家过敏与感染症研究中心、国家癌症研究中心、国家弱势民族与健康歧异中心、国家研究资源中心、国家健康研究中心等支持本研究。 Hoffmann-La Roche公司透过与国家健康研究中心的合作研发协议提供资金进行本研究。研究作者中有7人声明与Hoffmann-La Roche公司有各种财务关系。

Drinking Coffee Daily Linked to Lower Risk for Progression of Chronic Hepatitis C

By Laurie Barclay, MD
Medscape Medical News

November 2, 2009 — Drinking 3 or more cups of coffee per day is linked to a lower risk for progression of chronic hepatitis C, according to the results of a large prospective study reported online in the October 20 issue of Hepatology.

"This study is the first to address the association between liver disease progression related to hepatitis C and coffee intake," lead author Neal Freedman, PhD, MPH, from the National Cancer Institute in Rockville, Maryland, said in a news release. "Given the large number of people affected by HCV [hepatitis C virus] it is important to identify modifiable risk factors associated with the progression of liver disease. Although we cannot rule out a possible role for other factors that go along with drinking coffee, results from our study suggest that patients with high coffee intake had a lower risk of disease progression."

The study sample consisted of 766 participants in the Hepatitis C Antiviral Long-Term Treatment against Cirrhosis (HALT-C) trial who had hepatitis C–related bridging fibrosis or cirrhosis on liver biopsy and in whom peginterferon plus ribavirin treatment failed to achieve sustained virologic response.

During 3.8 years of follow-up, clinical outcomes were assessed every 3 months, including ascites, progression of chronic liver disease, liver-related mortality, hepatic encephalopathy, hepatocellular carcinoma, spontaneous bacterial peritonitis, variceal hemorrhage, or increased liver fibrosis. An additional outcome in participants without cirrhosis was a 2-point increase in Ishak fibrosis score on protocol biopsies performed at 1.5 and 3.5 years.

At baseline, higher intake of coffee consumption was associated with biopsy evidence of less severe steatosis, higher albumin levels, and lower serum aspartate aminotransferase-to-alanine aminotransferase ratio, alpha-fetoprotein, insulin levels, and homeostatic model assessment score (P < .05 for all comparisons).

Outcomes occurred in 230 patients, with lower rates associated with increased coffee consumption: 11.1/100 person-years for none, 12.1 for less than 1 cup/day, 8.2 for 1 to fewer than 3 cups/day, and 6.3 for 3 or more cups/day (P for trend = .0011). The corresponding relative risks (RRs) vs not drinking coffee were 1.11 (95% confidence interval [CI], 0.76 - 1.61) for less than 1 cup/day, 0.70 (95% CI, 0.48 - 1.02) for 1 to fewer than 3 cups/day, and 0.47 (95% CI, 0.27 - 0.85) for 3 or more cups/day (P for trend = .0003).

Treatment assignment or cirrhosis status at baseline did not affect risk estimates, and consumption of green or black tea was not associated with outcomes.

Limitations of this study include observational design; lack of generalizability to healthier populations; reliance on self-reported data; and lack of information on decaffeinated coffee, soft drinks, and coffee brewing methods.

"In a large prospective study of participants with advanced hepatitis C–related liver disease, regular coffee consumption was associated with lower rates of disease progression," the study authors write. "The association between coffee and liver disease progression observed in this study was independent of alcohol intake and cigarette smoking."

The National Institute of Diabetes and Digestive and Kidney Diseases, the National Institute of Allergy and Infectious Diseases, the National Cancer Institute, the National Center for Minority Health and Health Disparities and the National Center for Research Resources, National Institutes of Health, supported this study. Hoffmann-La Roche, Inc, provided additional funding to conduct this study through a Cooperative Research and Development Agreement with the National Institutes of Health. Seven of the study authors have disclosed various financial relationships with Hoffmann-La Roche, Inc.

Hepatology. 2009;50:1360-1369.?

    
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