Hedenstierna M, Nangarhari A, El-Sabini A, Weiland O, Aleman S
Department of Infectious Diseases, Danderyd Hospital, Stockholm, Sweden.
Division of Infectious Diseases, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
J Viral Hepat. 2018 Jul;25(7):802-810. doi: 10.1111/jvh.12879. Epub 2018 Mar 8.
We aimed to assess fibrosis with liver stiffness measurement long-term after sustained virological response of chronic hepatitis C and to identify risk factors associated with persisting fibrosis. In this cross-sectional study, patients with chronic hepatitis C and pretreatment advanced fibrosis or cirrhosis treated successfully at Karolinska University Hospital with an interferon-containing regimen underwent liver stiffness measurement with FibroScan. The impact of potential risk factors for persisting fibrosis was estimated. We included 269 patients with a median follow-up time of 7.7 years (range 0-20), 84 with a follow-up time of ≥10 years. Patients with pretreatment cirrhosis had a significantly higher median liver stiffness level (8.5 kPa 95% CI 7-9.1) at follow-up, than patients with advanced fibrosis (6 kPa 95% CI 5.5-6.4). A majority improved their fibrosis stage after sustained virological response, but 24% had persisting advanced fibrosis with a liver stiffness level of ≥ 9.5 kPa. Among patients with pretreatment cirrhosis, the proportion with persisting advanced fibrosis diminished with longer follow-up time, from 48% after <5 years to 21% after >10 years. The main risk factors for persisting advanced fibrosis were pretreatment cirrhosis, high age and body mass index. In conclusion, fibrosis improves substantially during long-term follow-up after sustained virological response in hepatitis C patients with pretreatment advanced liver fibrosis. Lifestyle intervention to decrease weight in obese persons and treatment before establishment of cirrhosis should therefore be recommended to avoid persistence of advanced fibrosis after virological cure.
我们旨在评估慢性丙型肝炎病毒学持续应答后长期肝脏硬度测量的纤维化情况，并确定与持续性纤维化相关的危险因素。在这项横断面研究中，于卡罗林斯卡大学医院接受含干扰素方案成功治疗的慢性丙型肝炎且治疗前有晚期纤维化或肝硬化的患者，接受了FibroScan肝脏硬度测量。评估了持续性纤维化潜在危险因素的影响。我们纳入了269例患者，中位随访时间为7.7年（范围0 - 20年），其中84例随访时间≥10年。随访时，治疗前有肝硬化的患者中位肝脏硬度水平（8.5 kPa，95%置信区间7 - 9.1）显著高于晚期纤维化患者（6 kPa，95%置信区间5.5 - 6.4）。大多数患者在病毒学持续应答后纤维化阶段有所改善，但24%的患者仍有晚期纤维化，肝脏硬度水平≥9.5 kPa。在治疗前有肝硬化的患者中，持续性晚期纤维化的比例随随访时间延长而降低，从<5年时的48%降至>10年时的21%。持续性晚期纤维化的主要危险因素是治疗前肝硬化、高龄和体重指数。总之，在治疗前有晚期肝纤维化的丙型肝炎患者病毒学持续应答后的长期随访中，纤维化有显著改善。因此，应建议肥胖者进行生活方式干预以减轻体重，并在肝硬化形成前进行治疗，以避免病毒学治愈后晚期纤维化的持续存在。
