Tada Toshifumi, Kumada Takashi, Toyoda Hidenori, Mizuno Kazuyuki, Sone Yasuhiro, Kataoka Saki, Hashinokuchi Shinichi
Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Gifu, Japan.
Department of Radiology, Ogaki Municipal Hospital, Ogaki, Gifu, Japan.
J Gastroenterol Hepatol. 2017 Dec;32(12):1982-1988. doi: 10.1111/jgh.13788.
There is insufficient research on whether direct-acting antiviral (DAA) therapy can improve liver fibrosis in patients with chronic hepatitis C virus (HCV). We evaluated sequential changes in liver stiffness using shear wave elastography in patients with HCV who received DAA therapy.
A total of 210 patients with HCV who received daclatasvir and asunaprevir therapy and achieved sustained virological response (SVR) were analyzed. Liver stiffness, as evaluated by shear wave elastography, and laboratory data were assessed before treatment (baseline), at end of treatment (EOT), and at 24 weeks after EOT (SVR24).
Alanine aminotransferase levels (ALT) decreased over time, and there were significant differences between baseline and EOT and between EOT and SVR24. Although platelet counts did not significantly differ between baseline and EOT, they increased significantly from EOT to SVR24. The median (interquartile range) liver stiffness values at baseline, EOT, and SVR24 were 10.2 (7.7-14.7), 8.8 (7.1-12.1), and 7.6 (6.3-10.3) kPa, respectively (P < 0.001, baseline vs EOT; P < 0.001, EOT vs SVR24). Additionally, in patients with ALT ≤ 30 (indicating low necroinflammatory activity in the liver) and Fibrosis-4 index > 2.0 (n = 75), the liver stiffness values at baseline, EOT, and SVR24 were 9.6 (7.7-15.2), 9.2 (7.3-12.1), and 7.7 (6.3-10.1) kPa, respectively (P < 0.001, baseline vs EOT; P < 0.001, EOT vs SVR24).
These results suggest that early improvement of liver stiffness starts during the administration of DAAs in patients who achieve SVR, and this effect is particularly pronounced in patients with progressive liver fibrosis.
关于直接抗病毒（DAA）疗法能否改善慢性丙型肝炎病毒（HCV）患者的肝纤维化，目前研究不足。我们使用剪切波弹性成像技术评估了接受DAA治疗的HCV患者肝脏硬度的连续变化。
共分析了210例接受达卡他韦和阿舒瑞韦治疗并实现持续病毒学应答（SVR）的HCV患者。通过剪切波弹性成像评估的肝脏硬度以及实验室数据在治疗前（基线）、治疗结束时（EOT）和EOT后24周（SVR24）进行评估。
丙氨酸氨基转移酶水平（ALT）随时间下降，基线与EOT之间以及EOT与SVR24之间存在显著差异。虽然血小板计数在基线与EOT之间无显著差异，但从EOT到SVR24显著增加。基线、EOT和SVR24时的肝脏硬度值中位数（四分位间距）分别为10.2（7.7 - 14.7）、8.8（7.1 - 12.1）和7.6（6.3 - 10.3）kPa（P < 0.001，基线与EOT比较；P < 0.001，EOT与SVR24比较）。此外，在ALT≤30（表明肝脏坏死性炎症活动低）且纤维化-4指数>2.0的患者（n = 75）中，基线、EOT和SVR24时的肝脏硬度值分别为9.6（7.7 - 15.2）、9.2（7.3 - 12.1）和7.7（6.3 - 10.1）kPa（P < 0.001，基线与EOT比较；P < 0.001，EOT与SVR24比较）。
这些结果表明，实现SVR的患者在接受DAA治疗期间肝脏硬度开始早期改善，且这种效应在进行性肝纤维化患者中尤为明显。
