Inoue Takako, Goto Takaaki, Iio Etsuko, Matsunami Kayoko, Fujiwara Kei, Shinkai Noboru, Matsuura Kentaro, Matsui Takeshi, Nojiri Shunsuke, Tanaka Yasuhito
Department of Clinical Laboratory, Nagoya City University Hospital, Nagoya, Japan.
Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Hepatol Res. 2018 Feb;48(3):E203-E212. doi: 10.1111/hepr.12970. Epub 2017 Sep 22.
Serum low-density lipoprotein cholesterol (LDL-C) increases during treatment of chronic hepatitis C (CHC) with interferon-free direct-acting antivirals (DAAs). We sought to compare the changes of serum lipid profiles caused by three regimens.
A total of 216 CHC patients were enrolled. Among 170 patients infected with hepatitis C virus (HCV) genotype 1b, 85 received daclatasvir plus asunaprevir (DCV/ASV) and 85 received sofosbuvir plus ledipasvir (SOF/LDV). Forty-six infected with HCV genotype 2 received sofosbuvir plus ribavirin (SOF/RBV). Serum total cholesterol (TC), LDL-C, high-density lipoprotein cholesterol, and triglyceride were measured at baseline and 4, 8, 12 (for all regimens), and 24 weeks (for DCV/ASV) during treatment (4w, 8w, 12w, and 24w, respectively) and 12 and 24 weeks after treatment (p12w and p24w, respectively).
In 69 (81.2%) patients who received DCV/ASV and achieved a sustained virologic response at 24 weeks after the end of treatment (SVR24), TC and LDL-C increased significantly from baseline to p24w. In 84 (98.8%) treated with SOF/LDV who achieved SVR24, TC and LDL-C increased significantly from baseline to 8w, and TC decreased significantly from 8w to p12w. The 45 (97.8%) who received SOF/RBV and achieved SVR24 showed no significant changes. At 12w, TC and LDL-C increased to a greater degree in patients receiving SOF/LDV than in those receiving DCV/ASV or SOF/RBV.
During treatment with DAAs, the serum lipid profile may reflect not only recovery from the disruption of lipid metabolism induced by HCV, but also the pharmacological effects of DAAs. Further investigations are needed to elucidate the effect of DAAs on serum lipid profiles.
在使用无干扰素直接抗病毒药物（DAA）治疗慢性丙型肝炎（CHC）期间，血清低密度脂蛋白胆固醇（LDL-C）会升高。我们试图比较三种治疗方案引起的血脂谱变化。
共纳入216例CHC患者。在170例感染丙型肝炎病毒（HCV）基因1b型的患者中，85例接受了达拉他韦加利匹韦林（DCV/ASV）治疗，85例接受了索磷布韦加维帕他韦（SOF/LDV）治疗。46例感染HCV基因2型的患者接受了索磷布韦加利巴韦林（SOF/RBV）治疗。在治疗期间（分别为4周、8周、12周和24周）以及治疗后12周和24周（分别为p12w和p24w）的基线、4周、8周、12周（所有治疗方案）和24周（DCV/ASV治疗方案）时测量血清总胆固醇（TC）、LDL-C、高密度脂蛋白胆固醇和甘油三酯。
在69例（81.2%）接受DCV/ASV治疗且在治疗结束后24周达到持续病毒学应答（SVR24）的患者中，从基线到p24w，TC和LDL-C显著升高。在84例（98.8%）接受SOF/LDV治疗且达到SVR24的患者中，从基线到8周，TC和LDL-C显著升高，且从8周到p12w，TC显著降低。45例（97.8%）接受SOF/RBV治疗且达到SVR24的患者未显示出显著变化。在12周时，接受SOF/LDV治疗的患者的TC和LDL-C升高程度大于接受DCV/ASV或SOF/RBV治疗 的患者。
在使用DAA治疗期间，血脂谱不仅可能反映从HCV诱导的脂质代谢紊乱中恢复的情况，还可能反映DAA的药理作用。需要进一步研究以阐明DAA对血脂谱的影响。
