Aby Elizabeth S, Dong Tien S, Kawamoto Jenna, Pisegna Joseph R, Benhammou Jihane N
Division of Gastroenterology, Hepatology and Parenteral Nutrition, Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, United States.
World J Hepatol. 2017 Dec 28;9(36):1352-1360. doi: 10.4254/wjh.v9.i36.1352.
To determine how sustained virological response at 12 wk (SVR12) with direct acting antivirals (DAAs) for the treatment of hepatitis C virus (HCV) infection affects chronic kidney disease (CKD) progression.
A retrospective analysis was performed in patients aged ≥ 18 years treated for HCV with DAAs at the VA Greater Los Angeles Healthcare System from 2014-2016. The treatment group was compared to patients with HCV from 2011-2013 who did not undergo HCV treatment, prior to the introduction of DAAs; the control group was matched to the study group in terms of age, gender, and ethnicity. Analysis of variance and co-variance was performed to compare means between SVR12 subgroups adjusting for co-variates.
Five hundred and twenty-three patients were evaluated. When comparing the rate of change in estimated glomerular filtration rate (eGFR) one-year after HCV treatment to one-year before treatment, patients who achieved SVR12 had a decline in GFR of 3.1 mL/min ± 0.75 mL/min per 1.73 m compared to a decline in eGFR of 11.0 mL/min ± 2.81 mL/min per 1.73 m in patients who did not achieve SVR12 ( = 0.002). There were no significant clinical differences between patients who achieved SVR12 compared to those who did not in terms of cirrhosis, treatment course, treatment experience, CKD stage prior to treatment, diuretic use or other co-morbidities. The decline in eGFR in those with untreated HCV over 2 years was 2.8 mL/min ± 1.0 mL/min per 1.73 m, which was not significantly different from the eGFR decline noted in HCV-treated patients who achieved SVR12 ( = 0.43).
Patients who achieve SVR12 have a lesser decline in renal function, but viral eradication in itself may not be associated improvement in renal disease progression.
确定使用直接抗病毒药物（DAA）治疗丙型肝炎病毒（HCV）感染时，12周持续病毒学应答（SVR12）如何影响慢性肾脏病（CKD）的进展。
对2014年至2016年在洛杉矶退伍军人事务部大洛杉矶医疗保健系统接受DAA治疗HCV的18岁及以上患者进行回顾性分析。将治疗组与2011年至2013年未接受HCV治疗（在DAA引入之前）的HCV患者进行比较；对照组在年龄、性别和种族方面与研究组匹配。进行方差分析和协方差分析，以比较在调整协变量后的SVR12亚组之间的均值。
共评估了523例患者。将HCV治疗后1年估计肾小球滤过率（eGFR）的变化率与治疗前1年进行比较，实现SVR12的患者每1.73平方米的GFR下降3.1毫升/分钟±0.75毫升/分钟，而未实现SVR12的患者每1.73平方米的eGFR下降11.0毫升/分钟±2.81毫升/分钟（P = 0.002）。在肝硬化、治疗疗程、治疗经验、治疗前CKD分期、利尿剂使用或其他合并症方面，实现SVR12的患者与未实现SVR12的患者之间没有显著的临床差异。未经治疗的HCV患者在2年内每1.73平方米的eGFR下降为2.8毫升/分钟±1.0毫升/分钟，这与实现SVR12的HCV治疗患者中观察到的eGFR下降没有显著差异（P = 0.43）。
实现SVR12的患者肾功能下降较小，但病毒根除本身可能与肾病进展的改善无关。
