丙型肝炎病毒根除可改善接受干扰素和利巴韦林治疗患者的即时和延迟情景记忆。
Hepatitis C virus eradication improves immediate and delayed episodic memory in patients treated with interferon and ribavirin.
作者信息
Barbosa Mary Ellen Dias, Zaninotto Ana Luiza, de Campos Mazo Daniel Ferraz, Pessoa Mario Guimarães, de Oliveira Cláudia Pinto Marques Souza, Carrilho Flair José, Farias Alberto Queiroz
机构信息
Division of Psychology, Clinics Hospital, University of Sao Paulo School of Medicine, Avenida Dr. Eneas Carvalho de Aguiar, 255, São Paulo, 05403-900, Brazil.
Division of Clinical Gastroenterology and Hepatology, Clinics Hospital, Department of Gastroenterology, University of São Paulo School of Medicine, Avenida Dr. Eneas Carvalho de Aguiar, 255, sala 9159, São Paulo, 05403-900, Brazil.
出版信息
BMC Gastroenterol. 2017 Nov 25;17(1):122. doi: 10.1186/s12876-017-0679-5.
BACKGROUND
Chronic hepatitis C virus (HCV) infection is associated with impairment of cognitive function and mood disorders. Our aim was to evaluate the impact of sustained virological response (SVR) on cognitive function and mood disorders.
METHOD
A prospective exploratory one arm study was conducted. Adult clinically compensated HVC patients were consecutively recruited before treatment with interferon and ribavirin for 24 to 48 weeks, according to HCV genotype. Clinical, neurocognitive and mood assessments using the PRIME-MD and BDI instruments were performed at baseline, right after half of the expected treatment has been reached and 6 months after the end of antiviral treatment. Exclusion criteria were the use of illicit psychotropic substances, mental confusion, hepatic encephalopathy, hepatocellular carcinoma, severe anemia, untreated hypothyroidism, Addison syndrome and major depression before treatment.
RESULTS
Thirty six patients were enrolled and 21 completed HCV treatment (n = 16 with SVR and n = 5 without). Regardless of the viral clearance at the end of treatment, there was a significant improvement in the immediate verbal episodic memory (p = 0.010), delayed verbal episodic memory (p = 0.007), selective attention (p < 0.001) and phonemic fluency (p = 0.043). Patients with SVR displayed significant improvement in immediate (p = 0.045) and delayed verbal episodic memory (p = 0.040) compared to baseline. The baseline frequency of depression was 9.5%, which rose to 52.4% during treatment, and returned to 9.5% 6 months after the end of treatment, without significant difference between patients with and without SVR. Depressive symptoms were observed in 19.1% before treatment, 62% during (p = 0.016) and 28.6% 6 months after the end of treatment (p = 0.719).
CONCLUSIONS
Eradication of HCV infection improved cognitive performance but did not affect the frequency of depressive symptoms at least in the short range.
背景
慢性丙型肝炎病毒（HCV）感染与认知功能损害和情绪障碍有关。我们的目的是评估持续病毒学应答（SVR）对认知功能和情绪障碍的影响。
方法
进行了一项前瞻性探索性单臂研究。根据HCV基因型，成年临床代偿性HVC患者在接受干扰素和利巴韦林治疗24至48周之前连续入组。在基线、预期治疗达到一半后以及抗病毒治疗结束6个月后，使用PRIME-MD和BDI工具进行临床、神经认知和情绪评估。排除标准为使用非法精神药物、精神错乱、肝性脑病、肝细胞癌、严重贫血、未治疗的甲状腺功能减退、艾迪生综合征以及治疗前的重度抑郁症。
结果
36名患者入组，21名完成了HCV治疗（n = 16达到SVR，n = 5未达到）。无论治疗结束时病毒是否清除，即时言语情景记忆（p = 0.010）、延迟言语情景记忆（p = 0.007）、选择性注意力（p < 0.001）和音素流畅性（p = 0.043）均有显著改善。与基线相比，达到SVR的患者在即时（p = 0.045）和延迟言语情景记忆方面有显著改善（p = 0.040）。抑郁的基线发生率为9.5%，治疗期间升至52.4%，治疗结束6个月后恢复至9.5%，达到SVR和未达到SVR的患者之间无显著差异。治疗前19.1%的患者出现抑郁症状，治疗期间为62%（p = 0.016），治疗结束6个月后为28.6%（p = 0.719）。
结论
根除HCV感染可改善认知表现，但至少在短期内不影响抑郁症状的发生率。
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