Service of Digestive Diseases and CIBERehd, University Hospital La Princesa, Universidad Autónoma, Madrid, Spain.
Rev Esp Enferm Dig. 2010 Jul;102(7):426-34. doi: 10.4321/s1130-01082010000700005.
The efficacy of combination therapy with peginterferon plus ribavirin to eradicate viral infection in patients with chronic hepatitis C (CHC) is well established; moreover, it is able to arrest or even reverse liver fibrosis.
To analyze the measurements of hepatic stiffness as an index of liver fibrosis using transient elastography (TE) in patients who underwent a sustained virological response (SVR) during long-term follow-up; comparing the changes in the severity of fibrosis with non-responders patients.
After hepatic fibrosis was studied in three patients with CHC who underwent a SVR during long-term follow up, a prospective study was initiated in 24 patients with CHC who received combination therapy to compare the evolution of fibrosis in those with SVR and those who were non-responders. The genotype of hepatitis C virus (HCV) and the degree of viremia were determined. METAVIR scoring system was used for liver fibrosis. Hepatic stiffness was measured by TE.
Of the initial three patients pre-treatment liver biopsies revealed active disease and fibrosis (stage 3) in two and mild fibrosis (stage 1) in one. After several years of follow up serum AST/ALT levels were normal and HCV RNA was undetectable in each case; in contrast to the baseline histological assessments of fibrosis, values for hepatic stiffness (3.4-6.9 KPa) were compatible with an absence of any appreciable hepatic fibrosis. In the prospective study, 8 patients underwent a SVR and 16 were non-responders. TE indicated that the severity of hepatic fibrosis in the SVR group improved in 7 (88%) patients, whereas in the non-responder it improved in only 4 (25%) (p < 0.05). The difference between development of severe fibrosis (F > or = 3) in responders and non-responders was not significant (p = 0.23), possibly due to the small sample size.
Regression of hepatic fibrosis appears to be common in patients with CHC who undergo a SVR. TE is a simple non-invasive technique that enables multiple assessments of the severity of hepatic fibrosis to be made efficiently during long-term follow-up of patients with CHC who receive combination antiviral therapy.
聚乙二醇干扰素联合利巴韦林治疗慢性丙型肝炎（CHC）患者的病毒感染的疗效已得到充分证实；此外，它还能够阻止甚至逆转肝纤维化。
分析长期随访中获得持续病毒学应答（SVR）的患者使用瞬时弹性成像（TE）检测肝纤维化的肝硬度指标，并比较应答者与无应答者患者的纤维化严重程度变化。
在对 3 例接受长期随访后获得 SVR 的 CHC 患者进行肝纤维化研究后，对 24 例接受联合治疗的 CHC 患者进行了前瞻性研究，以比较 SVR 患者和无应答者患者的纤维化演变。确定了丙型肝炎病毒（HCV）的基因型和病毒血症程度。采用 METAVIR 评分系统进行肝纤维化评分。TE 测量肝硬度。
在最初的 3 例患者中，治疗前肝活检显示 2 例存在活动期疾病和纤维化（3 期），1 例存在轻度纤维化（1 期）。经过几年的随访，每位患者的血清 AST/ALT 水平均正常，HCV RNA 均无法检测到；与基线纤维化的组织学评估相比，肝硬度值（3.4-6.9kPa）提示无明显肝纤维化。在前瞻性研究中，8 例患者获得 SVR，16 例患者无应答。TE 表明 SVR 组 7 例（88%）患者的肝纤维化严重程度改善，而无应答者中仅 4 例（25%）改善（p<0.05）。应答者和无应答者发生严重纤维化（F≥3）的差异无统计学意义（p=0.23），可能是由于样本量小。
在接受联合抗病毒治疗的 CHC 患者中，获得 SVR 的患者肝纤维化似乎出现逆转。TE 是一种简单的无创技术，可在接受聚乙二醇干扰素联合利巴韦林治疗的 CHC 患者的长期随访中有效地进行多次肝纤维化严重程度评估。
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