Rincon Diego, Ripoll Cristina, Lo Iacono Oreste, Salcedo Magdalena, Catalina Maria V, Alvarez Emilio, Nuñez Oscar, Matilla Ana M, Clemente Gerardo, Bañares Rafael
Liver and Transplant Unit, Hospital General Universitario Gregorio Marañon, Madrid, Spain.
Am J Gastroenterol. 2006 Oct;101(10):2269-74. doi: 10.1111/j.1572-0241.2006.00743.x.
Antiviral therapy (AVT) may improve liver histology in patients with advanced viral hepatitis but its effect on portal pressure remains unknown.
This study was aimed to evaluate the influence of antiviral therapy (AVT) on hepatic venous pressure gradient (HVPG) in hepatitis C virus infected patients with portal hypertension.
Twenty compensated patients with chronic hepatitis C, fibrosis stage 3 or 4 and HVPG > 5 mmHg received PEG-IFN alpha2b plus ribavirin. Every patient underwent liver biopsy and portal pressure measurements before and immediately after AT. Biopsies were evaluated according to METAVIR score.
HVPG significantly dropped in all but one treated patient, with a mean (SD) reduction of 28.2 (12)%[13.8 (5.6) Vs. 10.2 (3.8) mmHg, p = 0.005]. The percentage of HVPG decrease was significantly greater in patients who achieved a virological end of treatment response [26.2 (12.5)% Vs. 12.7 (8.5)%, p = 0.05] and in those with a decrease of at least 2 points in the grade of inflammation [35.7 (4.5)% Vs. 22.1 (9.5)%, p = 0.015]. Nine out of 11 patients with baseline HVPG > or = 12 mmHg showed a decrease greater than 20% (3/11) or under the 12 mmHg threshold (6/11).
AVT reduces HVPG in compensated patients with advanced hepatitis C (fibrosis stage 3 or 4) and portal hypertension.
抗病毒治疗（AVT）可能改善晚期病毒性肝炎患者的肝脏组织学，但对门静脉压力的影响尚不清楚。
本研究旨在评估抗病毒治疗（AVT）对丙型肝炎病毒感染的门静脉高压患者肝静脉压力梯度（HVPG）的影响。
20例代偿期慢性丙型肝炎患者，纤维化3或4期，HVPG>5 mmHg，接受聚乙二醇干扰素α2b联合利巴韦林治疗。每位患者在抗病毒治疗前和治疗后立即进行肝活检和门静脉压力测量。活检根据METAVIR评分进行评估。
除1例治疗患者外，所有患者的HVPG均显著下降，平均（标准差）下降28.2（12）%[13.8（5.6）对10.2（3.8）mmHg，p = 0.005]。治疗结束时达到病毒学应答的患者HVPG下降百分比显著更高[26.2（12.5）%对12.7（8.5）%，p = 0.05]，炎症分级至少下降2分的患者也是如此[35.7（4.5）%对22.1（9.5）%，p = 0.015]。11例基线HVPG≥12 mmHg的患者中有9例下降超过20%（3/11）或降至12 mmHg阈值以下（6/11）。
抗病毒治疗可降低代偿期晚期丙型肝炎（纤维化3或4期）和门静脉高压患者的HVPG。
