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作者：Laurie Barclay, MD  
出處：WebMD醫學新聞

　　【24drs.com】November 2, 2009 — 根據線上登載於10月20日Hepatology期刊的一篇大型前瞻性研究結果，每天喝3杯以上咖啡與降低慢性C型肝炎惡化風險有關。
　　
　　第一作者、國家癌症研究中心的Neal Freedman博士在新聞稿中表示，這是首次描述與C型肝炎有關的肝病惡化和喝咖啡之關聯的研究。因為有許多人感染C型肝炎病毒(HCV [hepatitis C virus])，因此確認與肝病惡化相關的可調整風險因素很重要。雖然我們無法排除喝咖啡之外的其他因素的可能性，但我們的研究結果認為，喝較多咖啡的病患，其疾病惡化風險較低。
　　
　　研究樣本包括「Hepatitis C Antiviral Long-Term Treatment against Cirrhosis (HALT-C)」試驗的766名研究對象，肝臟切片有C型肝炎相關橋狀纖維化或肝硬化，且peginterferon加ribavirin治療無法達到病毒持續性反應。
　　
　　在3.8年的追蹤期間，每三個月評估一次臨床結果，包括腹水、慢性肝病惡化、肝臟相關死亡率、肝性腦病變、肝細胞腫瘤、自發性細菌性腹膜炎、靜脈曲張出血或肝纖維化增加。沒有肝硬化的研究對象中，還有一個結果，在第1.5和3.5年進行的預定切片中，Ishak肝臟纖維化指數增加2分。
　　
　　開始時，喝較多咖啡與切片較少嚴重脂肪變性、白蛋白值較高、血清AST/ALT比值較低、α-胎兒蛋白值較低、胰島素值較低、以及體內平衡模型評估等有關(各項比較之P < .05)。
　　
　　在230名病患中，與增加咖啡攝取量而降低相關比率的結果為：每100人-年中，11.1人完全沒喝、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(趨勢P值 = .0011)。相較於未喝咖啡者的對應相對風險為，喝不到1杯者為1.11 (95%信賴區間[CI]為0.76 - 1.61)、喝1-3杯者為0.70 (95% CI為0.48 - 1.02)、喝3杯以上者為0.47 (95% CI為0.27 - 0.85) (趨勢P值 = .0003)。
　　
　　開始時的指定治療方式或肝硬化狀態並不會影響風險評估，飲用較多綠茶或紅茶與結果無關。
　　
　　研究限制包括觀察性研究設計；無法一般化到健康族群；採用自我報告的資料；缺乏有關無咖啡因咖啡、汽水與咖啡釀煮方式的資料。
　　
　　研究作者寫道，在一個末期C型肝炎相關肝病患者的大型前瞻性研究中，規律飲用咖啡與疾病惡化率較低有關。本研究觀察到的咖啡與肝病惡化之間的關聯，與飲酒和抽菸無關。
　　
　　國家糖尿病與消化道與腎病研究中心、國家過敏與感染症研究中心、國家癌症研究中心、國家弱勢民族與健康歧異中心、國家研究資源中心、國家健康研究中心等支持本研究。 Hoffmann-La Roche公司透過與國家健康研究中心的合作研發協議提供資金進行本研究。研究作者中有7人聲明與Hoffmann-La Roche公司有各種財務關係。  

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.?