Sezione di Gastroenterologia, Di.Bi.M.I.S, Università di Palermo, Italia.
Hepatology. 2012 May;55(5):1317-23. doi: 10.1002/hep.25508. Epub 2012 Apr 4.
There are contrasting results in studies of cardiovascular risk in patients with genotype 1 chronic hepatitis C (G1 CHC). We evaluated the prevalence of carotid atherosclerosis compared with a control population in order to assess the potential association between atherosclerosis, host and viral factors, and liver histological features. In all, 174 consecutive biopsy-proven G1 CHC patients were evaluated by anthropometric and metabolic measurements and 174 patients attending an outpatient cardiology unit were used as controls. Intima-media thickness (IMT) and carotid plaques, defined as focal thickening of >1.3 mm at the level of common carotid, were evaluated using ultrasonography. All G1 CHC biopsies were scored by one pathologist for staging and grading, and graded for steatosis. Carotid plaques were found in 73 (41.9%) G1 CHC patients compared with 40 (22.9%) control patients (P < 0.001). Similarly, G1 CHC patients had a greater IMT compared with control patients (1.04 ± 0.21 versus 0.90 ± 0.16; P < 0.001). Multivariate logistic regression analysis showed that older age (odds ratio [OR] 1.047, 95% confidence interval [CI]: 1.014-1.082, P = 0.005), and severe hepatic fibrosis (OR 2.177, 95% CI: 1.043-4.542, P = 0.03), were independently linked to the presence of carotid plaques. In patients ≤55 years, 15/67 cases with F0-F2 fibrosis (22.3%) had carotid plaques, compared with 11/21 (52.3%) with F3-F4 fibrosis (P = 0.008). By contrast, in patients >55 years the prevalence of carotid plaques was similar in those with or without severe fibrosis (25/43, 58.1% versus 22/43, 51.1%; P = 0.51).
Severe hepatic fibrosis is associated with a high risk of early carotid atherosclerosis in G1 CHC patients.
在基因型 1 慢性丙型肝炎（G1 CHC）患者中，心血管风险的研究结果存在差异。我们评估了颈动脉粥样硬化的患病率，并与对照人群进行了比较，以评估动脉粥样硬化、宿主和病毒因素以及肝组织学特征之间的潜在关联。共有 174 例连续活检证实的 G1 CHC 患者接受了人体测量和代谢测量，174 例在门诊心脏病科就诊的患者被用作对照。使用超声评估颈动脉内膜中层厚度（IMT）和颈动脉斑块，定义为颈总动脉水平处＞1.3mm 的局灶性增厚。所有 G1 CHC 活检均由一名病理学家进行分期和分级评分，并对脂肪变性进行分级。与 40 例对照患者（22.9%）相比，73 例（41.9%）G1 CHC 患者存在颈动脉斑块（P＜0.001）。同样，与对照患者相比，G1 CHC 患者的 IMT 更大（1.04±0.21 与 0.90±0.16；P＜0.001）。多变量逻辑回归分析显示，年龄较大（比值比[OR]1.047，95%置信区间[CI]：1.014-1.082，P=0.005）和严重肝纤维化（OR 2.177，95%CI：1.043-4.542，P=0.03）与颈动脉斑块的存在独立相关。在≤55 岁的患者中，67 例 F0-F2 纤维化患者中有 15 例（22.3%）存在颈动脉斑块，而 21 例 F3-F4 纤维化患者中有 11 例（52.3%）存在颈动脉斑块（P=0.008）。相比之下，在＞55 岁的患者中，有严重纤维化和无严重纤维化患者的颈动脉斑块患病率相似（43 例中有 25 例[58.1%]和 43 例中有 22 例[51.1%]；P=0.51）。
严重肝纤维化与 G1 CHC 患者早期颈动脉粥样硬化的高风险相关。
