Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg 69120, Germany.
Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital of Magdeburg, Magdeburg 39120, Germany.
World J Gastroenterol. 2018 Feb 21;24(7):852-861. doi: 10.3748/wjg.v24.i7.852.
To define predictors of functional benefit of direct-acting antivirals (DAAs) in patients with chronic hepatitis C virus (HCV) infection and liver cirrhosis.
We analysed a cohort of 199 patients with chronic HCV genotype 1, 2, 3 and 4 infection involving previously treated and untreated patients with compensated (76%) and decompensated (24%) liver cirrhosis at two tertiary centres in Germany. Patients were included with treatment initiation between February 2014 and August 2016. All patients received a combination regimen of one or more DAAs for either 12 or 24 wk. Predictors of functional benefit were assessed in a univariable as well as multivariable model by binary logistic regression analysis.
Viral clearance was achieved in 88% (175/199) of patients. Sustained virological response (SVR) 12 rates were as follows: among 156 patients with genotype 1 infection the SVR 12 rate was 90% ( = 141); among 7 patients with genotype 2 infection the SVR 12 rate was 57% ( = 4); among 30 patients with genotype 3 infection the SVR 12 rate was 87% ( = 26); and among 6 patients with genotype 4 infection the SVR 12 rate was 67% ( = 4). Follow-up MELD scores were available for 179 patients. A MELD score improvement was observed in 37% (65/179) of patients, no change of MELD score in 41% (74/179) of patients, and an aggravation was observed in 22% (40/179) of patients. We analysed predictors of functional benefit from antiviral therapy in our patients beyond viral eradication. We identified the Child-Pugh score, the MELD score, the number of platelets and the levels of albumin and bilirubin as significant factors for functional benefit.
Our data may contribute to the discussion of potential risks and benefits of antiviral therapy with individual patients infected with HCV and with advanced liver disease.
确定直接作用抗病毒药物（DAAs）治疗慢性丙型肝炎病毒（HCV）感染合并肝硬化患者的功能性获益的预测因素。
我们分析了德国两个三级中心的 199 例慢性 HCV 基因型 1、2、3 和 4 感染的患者队列，这些患者包括既往治疗和未治疗的代偿性（76%）和失代偿性（24%）肝硬化患者。患者在 2014 年 2 月至 2016 年 8 月期间开始接受治疗。所有患者均接受一种或多种 DAA 的联合治疗方案，疗程为 12 或 24 周。采用二元逻辑回归分析在单变量和多变量模型中评估功能性获益的预测因素。
199 例患者中，88%（175/199）实现了病毒清除。以下是不同基因型患者的持续病毒学应答（SVR）12 率：156 例基因型 1 感染患者的 SVR 12 率为 90%（=141）；7 例基因型 2 感染患者的 SVR 12 率为 57%（=4）；30 例基因型 3 感染患者的 SVR 12 率为 87%（=26）；6 例基因型 4 感染患者的 SVR 12 率为 67%（=4）。179 例患者的随访 MELD 评分可用。37%（65/179）的患者 MELD 评分改善，41%（74/179）的患者 MELD 评分无变化，22%（40/179）的患者 MELD 评分恶化。我们分析了除病毒清除外，抗病毒治疗对患者功能性获益的预测因素。我们发现，Child-Pugh 评分、MELD 评分、血小板计数以及白蛋白和胆红素水平是功能性获益的显著因素。
我们的数据可能有助于讨论 HCV 感染和晚期肝病患者接受抗病毒治疗的潜在风险和获益。
