Medizinische Klinik 1, Klinikum der Goethe-Universität, Frankfurt am Main, Germany.
PLoS One. 2013 Aug 1;8(8):e71262. doi: 10.1371/journal.pone.0071262. Print 2013.
In patients with advanced liver cirrhosis due to chronic hepatitis C virus (HCV) infection antiviral therapy with peginterferon and ribavirin is feasible in selected cases only due to potentially life-threatening side effects. However, predictive factors associated with hepatic decompensation during antiviral therapy are poorly defined.
In a retrospective cohort study, 68 patients with HCV-associated liver cirrhosis (mean MELD score 9.18 ± 2.72) were treated with peginterferon and ribavirin. Clinical events indicating hepatic decompensation (onset of ascites, hepatic encephalopathy, upper gastrointestinal bleeding, hospitalization) as well as laboratory data were recorded at baseline and during a follow up period of 72 weeks after initiation of antiviral therapy. To monitor long term sequelae of end stage liver disease an extended follow up for HCC development, transplantation and death was applied (240 weeks, ± SD 136 weeks).
Eighteen patients (26.5%) achieved a sustained virologic response. During the observational period a hepatic decompensation was observed in 36.8%. Patients with hepatic decompensation had higher MELD scores (10.84 vs. 8.23, p<0.001) and higher mean bilirubin levels (26.74 vs. 14.63 µmol/l, p<0.001), as well as lower serum albumin levels (38.2 vs. 41.1 g/l, p=0.015), mean platelets (102.64 vs. 138.95/nl, p=0.014) and mean leukocytes (4.02 vs. 5.68/nl, p=0.002) at baseline as compared to those without decompensation. In the multivariate analysis the MELD score remained independently associated with hepatic decompensation (OR 1.56, 1.18-2.07; p=0.002). When the patients were grouped according to their baseline MELD scores, hepatic decompensation occurred in 22%, 59%, and 83% of patients with MELD scores of 6-9, 10-13, and >14, respectively. Baseline MELD score was significantly associated with the risk for transplantation/death (p<0.001).
Our data suggest that the baseline MELD score predicts the risk of hepatic decompensation during antiviral therapy and thus contributes to decision making when antiviral therapy is discussed in HCV patients with advanced liver cirrhosis.
在因慢性丙型肝炎病毒（HCV）感染导致晚期肝硬化的患者中，由于可能存在危及生命的副作用，只有在特定情况下才可行抗病毒治疗联合聚乙二醇干扰素和利巴韦林。然而，与抗病毒治疗期间肝失代偿相关的预测因素尚不清楚。
在一项回顾性队列研究中，68 例丙型肝炎相关肝硬化患者（平均 MELD 评分 9.18±2.72）接受了聚乙二醇干扰素和利巴韦林治疗。在抗病毒治疗开始后的 72 周随访期间，记录了临床事件（腹水、肝性脑病、上消化道出血、住院）和实验室数据，以指示肝失代偿。为监测终末期肝病的长期后果，应用了 HCC 发展、移植和死亡的扩展随访（240 周，±SD 136 周）。
18 例患者（26.5%）获得持续病毒学应答。在观察期间，36.8%的患者发生肝失代偿。发生肝失代偿的患者 MELD 评分更高（10.84 与 8.23，p<0.001），胆红素水平更高（26.74 与 14.63μmol/L，p<0.001），血清白蛋白水平更低（38.2 与 41.1g/L，p=0.015），血小板计数更低（102.64 与 138.95/μl，p=0.014），白细胞计数更低（4.02 与 5.68/μl，p=0.002）。多变量分析显示 MELD 评分与肝失代偿独立相关（OR 1.56，1.18-2.07；p=0.002）。根据基线 MELD 评分，MELD 评分分别为 6-9、10-13 和>14 的患者中，肝失代偿的发生率分别为 22%、59%和 83%。基线 MELD 评分与移植/死亡风险显著相关（p<0.001）。
我们的数据表明，基线 MELD 评分可预测抗病毒治疗期间肝失代偿的风险，因此有助于在讨论丙型肝炎晚期肝硬化患者的抗病毒治疗时做出决策。
