Inter-Centre Unit of Digestive Diseases and CIBERehd, Virgen del Rocio-Virgen Macarena University Hospitals, Sevilla, Spain.
Inter-Centre Unit of Digestive Diseases and CIBERehd, Virgen del Rocio-Virgen Macarena University Hospitals, Sevilla, Spain; Institute of Biomedicine of Seville, Sevilla, Spain.
Clin Microbiol Infect. 2016 Oct;22(10):839-845. doi: 10.1016/j.cmi.2016.09.017. Epub 2016 Sep 24.
Fibrosis progression is common in hepatitis C. Both host and viral factors influence its natural history. Liver fibrosis is a key predictive factor for advanced disease including endpoints such as liver failure, cirrhosis and hepatocellular carcinoma (HCC). METAVIR fibrosis stages F3-F4 have been considered as the threshold for antiviral therapy. However, this aspect is controversial after the advent of new direct-acting antivirals (DAAs) because they show an excellent efficacy and safety profile. Moreover, in the DAA era, fibrosis stage seems not to be a predictive factor of a sustained virological response (SVR). Viral eradication decreases liver damage by improving the inflammation, as well as by regressing fibrosis irrespective of the treatment regimen. Non-invasive methods are useful in the assessment of liver fibrosis, replacing liver biopsy in clinical practice; but their usefulness for monitoring fibrosis after SVR needs to be demonstrated. Fibrosis regression has been demonstrated after the eradication of hepatitis C virus infection and is associated with a lower risk of hepatic cirrhosis and liver cancer. However, patients showing advanced fibrosis and cirrhosis must be followed-up after SVR, as risks of portal hypertension and HCC remain.
肝纤维化是慢性丙型肝炎进展的重要标志，其发生发展受宿主和病毒等多种因素的影响。肝纤维化是慢性丙型肝炎疾病进展的关键预测因素，与肝衰竭、肝硬化和肝细胞癌（HCC）等终点事件密切相关。METAVIR 纤维化分期 F3-F4 一直被认为是抗病毒治疗的阈值。然而，新型直接抗病毒药物（DAA）问世后，这一观点受到了挑战，因为 DAA 具有出色的疗效和安全性。此外，在 DAA 时代，纤维化分期似乎不再是持续病毒学应答（SVR）的预测因素。病毒清除可通过改善炎症和逆转纤维化来减轻肝损伤，而无论治疗方案如何。非侵入性方法在肝纤维化评估中具有重要作用，可替代肝活检在临床实践中的应用；但这些方法在 SVR 后监测纤维化的作用尚需进一步证实。丙型肝炎病毒感染的清除可导致肝纤维化的逆转，并降低肝硬化和肝癌的风险。然而，对于存在晚期纤维化和肝硬化的患者，即使在 SVR 后仍需进行随访，因为门静脉高压和 HCC 的风险仍然存在。
