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。
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.
