만성 C형 간염에서 아포지단백E 유전자형과 치료반응과의 관련성
Association between Apolipoprotein E Genotype and Treatment Response in Chronic Hepatitis C
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배경: C형 간염 바이러스(Hepatitis C virus, HCV)는 점진적인 간 손상을 야기하는 만성감염의 원인이다. 최근 HCV가 간세포내로 유입되는 과정과 관련하여 아포지단백E (apolipoprotein E, ApoE)의 유전자형이 HCV 병리작용에 영향을 주게되어 HCV 감염시 간손상을 막아줄 수 있다는 연구들이 보고되었다. 저자들은 만성 C형 간염 환자들의 ApoE 유전자형과HCV 감염과 관련된 임상양상을 조사하여 연관성을 분석하였다. 방법: 196명의 만성 C형 간염 환자들의 전혈로 allele specific 중합효소연쇄반응을 이용해 ApoE 유전자형을 분석하였다. 간 효소, 혈소판 수 및 HCV 바이러스 양과 같은 여러 검사결과와 방사선학적 소견을 조사하였고, 치료반응평가를 위해HCV 바이러스 양을 기준으로 지속적 바이러스 반응(sustained virologic response, SVR), 초기 바이러스 반응(early virologic response, EVR) 및 치료 종료 반응(end of treatment response, ETR)을 판정하였다. 결과: 전체 대상군의 ApoE 유전자형의 분포는 E4 양성군(E2/E4, E3/E4, E4/E4)이 31명으로 전체의 15.8%였고, E4 음성군(E2/E2, E2/E3, E3/E3)은 165명으로 84.2%였다. E4 양성군의 간 효소, 알부민, 혈소판수, HCV 바이러스 양 및 간의 거친소견과 같은 임상결과들은 E4 음성군과 유의한 차이가 없었고. SVR, EVR 및 ETR 역시 두 그룹 간의 차이가 없었다. 결론: 만성 C형 간염환자에서 ApoE 유전자형은 HCV 감염의 임상양상과 SVR, EVR 및 ETR과 같은 치료반응에 유의한영향이 없었다.
Abstract
Background: Hepatitis C virus (HCV) causes a chronic infection, resulting in progressive liver damage. Recent studies have described the protective effect of the apolipoprotein E (ApoE) genotype on liver damage in cases of HCV infection. Their findings were explained by the influence of the ApoE genotype on HCV pathology, which seems to be integrally linked to the process of HCV uptake into hepatocytes. We investigated whether specific ApoE genotypes were associated with the different clinical aspects of HCV infection in patients with chronic HCV. Methods: From the whole blood of 196 chronic HCV hepatitis patients, the ApoE genotypes were determined by an allele-specific polymerase chain reaction. Several markers, including liver enzymes, platelet counts and HCV viral loads, as well as the radiologic findings, were investigated. In order to estimate the treatment outcome, the sustained virologic response (SVR), early virologic response (EVR) and end-of-treatment response (ETR) were determined according to the HCV viral loads. Results: Based on genotyping, 15.8% (n=31) of the patients had the ApoE E4 allele (E2/E4, E3/E4, E4/E4), while 84.2% (n=165) were missing the ApoE E4 allele (E2/E2, E2/E3, E3/E3). Several clinical results of the E4-positive group, including liver enzymes, albumin, platelet counts, HCV viral loads and hepatic coarseness were not significantly different from those of E4-negative group. There were no differences in the SVR, EVR and ETR between patients with the ApoE E4 allele and those without the ApoE E4 allele. Conclusion: There was no significant effect of the ApoE genotype on the clinical aspects of HCV infection and the anti-viral response, including SVR, EVR and ETR, in chronic HCV hepatitis patients.
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