Grgurevic Ivica, Bozin Tonci, Madir Anita
Department of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital Dubrava, Zagreb, Croatia.
University of Zagreb School of Medicine, Zagreb, Croatia.
Clin Exp Hepatol. 2017 Dec;3(4):181-186. doi: 10.5114/ceh.2017.71491. Epub 2017 Nov 16.
Results from the interferon era have demonstrated reversibility of cirrhosis following viral eradication, but only for patients in the initial stage of cirrhosis. Although direct-acting antivirals (DAA) represent revolutionary treatment of hepatitis C, there are currently no studies showing histological effects of therapy on a large number of cirrhotic patients. However, studies involving transient elastography demonstrated a rapid decrease in liver stiffness after successful DAA therapy, probably due to resolution of inflammation, rather than fibrosis regression, as the latter requires a longer period of time. Reversal of fibrosis and cirrhosis upon viral eradication is a prerequisite for the reduction of portal pressure, but this effect has only been observed for the subclinical stage of portal hypertension (PH). On the other hand, the majority of patients with clinically significant PH remain at risk of decompensation and death, despite hepatitis C virus cure, as PH remains high in this setting. This calls for novel therapeutic approaches.
干扰素时代的研究结果表明，病毒清除后肝硬化具有可逆性，但仅适用于肝硬化初期的患者。尽管直接抗病毒药物（DAA）代表了丙型肝炎的革命性治疗方法，但目前尚无研究表明该疗法对大量肝硬化患者的组织学影响。然而，涉及瞬时弹性成像的研究表明，成功的DAA治疗后肝脏硬度迅速下降，这可能是由于炎症消退，而非纤维化逆转，因为后者需要更长的时间。病毒清除后纤维化和肝硬化的逆转是降低门静脉压力的先决条件，但这种效果仅在门静脉高压（PH）的亚临床阶段观察到。另一方面，大多数具有临床显著PH的患者尽管丙型肝炎病毒已治愈，但仍有失代偿和死亡的风险，因为在此情况下PH仍然很高。这就需要新的治疗方法。
