Bashir Muhammad H, Fazili Javid, Madhoun Mohammad F, Kanagala Rajesh, Chen Sixia, Nusrat Salman
Department of Internal Medicine.
Department of Digestive Disease and Nutrition.
Eur J Gastroenterol Hepatol. 2018 Mar;30(3):296-301. doi: 10.1097/MEG.0000000000001032.
Hepatitis C virus (HCV) is a common cause of cirrhosis, leading to increased morbidity and mortality. Treatment of the underlying etiology has been shown to improve fibrosis and cirrhosis.
We sought to evaluate the impact of a sustained virologic response on liver chemistries, model for end stage liver disease (MELD) score, Child-Pugh-Turcotte score (CPT), and fibrosis 4 score (FIB4) in patients with liver cirrhosis secondary to HCV with portal hypertension, with or without decompensation.
Patients with HCV seen in our transplant clinic between June 2013 and September 2015 were identified using ICD-9 code 573.3. Charts were reviewed retrospectively.
We collected data from 92 patients with a mean pretreatment MELD score of 9.16±2.98. The most common genotype was Ia, n=79 (86%). The mean duration of follow-up was 7.52±2.25 months. Transaminitis improved significantly at follow-up versus pretreatment [mean aspartate transaminase from 81.2±62.9 to 32.4±12.0 (P<0.0001); alanine transaminase 74.7±77.8 to 27.7±19.4 (P<0.0001)]. Albumin, bilirubin, and α-fetoprotein improved significantly. MELD scores improved in patients with pretreatment scores greater than 10 (P<0.0003), but not in patients with pretreatment scores less than 10 (P=0.501). The CPT score decreased from 6.1±0.9 to 5.8±0.9 (P<0.0024). The FIB4 score improved significantly in patients with baseline FIB4 more than 3.24, but not with higher baseline FIB4.
Use of direct antivirals in patients with decompensated cirrhosis because of HCV leads to improved MELD, FIB4, and CPT scores.
丙型肝炎病毒（HCV）是肝硬化的常见病因，会导致发病率和死亡率上升。已证明针对潜在病因进行治疗可改善纤维化和肝硬化情况。
我们旨在评估持续病毒学应答对伴有门静脉高压的HCV继发性肝硬化患者（无论有无失代偿）的肝脏生化指标、终末期肝病模型（MELD）评分、Child-Pugh-Turcotte评分（CPT）和纤维化4评分（FIB4）的影响。
使用ICD-9编码573.3识别2013年6月至2015年9月期间在我们移植门诊就诊的HCV患者。对病历进行回顾性审查。
我们收集了92例患者的数据，其治疗前平均MELD评分为9.16±2.98。最常见的基因型为Ia型，n = 79（86%）。平均随访时间为7.52±2.25个月。与治疗前相比，随访时转氨酶水平显著改善[平均天冬氨酸转氨酶从81.2±62.9降至32.4±12.0（P<0.0001）；丙氨酸转氨酶从74.7±77.8降至27.7±19.4（P<0.0001）]。白蛋白、胆红素和甲胎蛋白显著改善。治疗前评分大于10的患者MELD评分有所改善（P<0.0003），但治疗前评分小于10的患者则未改善（P = 0.501）。CPT评分从6.1±0.9降至5.8±0.9（P<0.0024）。基线FIB4大于3.24的患者FIB4评分显著改善，但基线FIB4较高的患者则未改善。
对因HCV导致失代偿性肝硬化的患者使用直接抗病毒药物可使MELD、FIB4和CPT评分得到改善。
