Sezione di Gastroenterologia e Epatologia, Di.Bi.M.I.S, Università di Palermo, Italy.
Department of Medical, Surgical, Neurological, Geriatric, and Metabolic Sciences, University of Campania "Luigi Vanvitelli", 80100 Naples, Italy.
J Hepatol. 2018 Jul;69(1):18-24. doi: 10.1016/j.jhep.2018.02.015. Epub 2018 Mar 2.
Recent studies suggest an association between hepatitis C virus (HCV) infection and cardiovascular damage, including carotid atherosclerosis, with a possible effect of HCV clearance on cardiovascular outcomes. We aimed to examine whether HCV eradication by direct-acting antiviral agents (DAA) improves carotid atherosclerosis in HCV-infected patients with advanced fibrosis/compensated cirrhosis.
One hundred eighty-two consecutive patients with HCV and advanced fibrosis or compensated cirrhosis were evaluated. All patients underwent DAA-based antiviral therapy according to AISF/EASL guidelines. Intima-media thickness (IMT), carotid thickening (IMT ≥1 mm) and carotid plaques, defined as focal thickening of ≥1.5 mm at the level of the common carotid, were evaluated by ultrasonography (US) at baseline and 9-12 months after the end of therapy. Fifty-six percent of patients were male, mean age 63.1 ± 10.4 years, and 65.9% had compensated cirrhosis. One in five had diabetes, 14.3% were obese, 41.8% had arterial hypertension and 35.2% were smokers. At baseline, mean IMT was 0.94 ± 0.29 mm, 42.8% had IMT ≥1 mm, and 42.8% had carotid plaques.
All patients achieved a 12-week sustained virological response. IMT significantly decreased from baseline to follow-up (0.94 ± 0.29 mm vs. 0.81 ± 0.27, p <0.001). Consistently, a significant reduction in the prevalence of patients with carotid thickening from baseline to follow-up was observed (42.8% vs. 17%, p <0.001), while no changes were reported for carotid plaques (42.8% vs. 47.8%, p = 0.34). These results were confirmed in subgroups of patients stratified for cardiovascular risk factors and liver disease severity.
HCV eradication by DAA improves carotid atherosclerosis in patients with severe fibrosis with or without additional metabolic risk factors. The impact of this improvement in the atherosclerotic burden in terms of reduction of major cardiovascular outcomes is worth investigating in the long term.
Hepatitis C virus eradication by direct-acting antiviral agents improves carotid atherosclerosis in patients with advanced fibrosis/compensated cirrhosis. The improvement in intima-media thickness and carotid thickening was confirmed after stratification for severity of liver disease and cardiovascular risk factors. Hepatitis C virus eradication by direct-acting antiviral agents also lead to improvement in glucose homeostasis and increased cholesterol levels.
最近的研究表明，丙型肝炎病毒（HCV）感染与心血管损伤之间存在关联，包括颈动脉粥样硬化，而 HCV 清除可能对心血管结局产生影响。我们旨在研究直接作用抗病毒药物（DAA）是否能改善 HCV 感染、纤维化程度晚期或代偿性肝硬化患者的颈动脉粥样硬化。
评估了 182 例连续的 HCV 感染且纤维化程度晚期或代偿性肝硬化患者。所有患者均按照 AISF/EASL 指南接受了基于 DAA 的抗病毒治疗。基线时和治疗结束后 9-12 个月，通过超声检查评估内膜中层厚度（IMT）、颈动脉增厚（IMT≥1mm）和颈动脉斑块，定义为颈总动脉水平的局灶性增厚≥1.5mm。56%的患者为男性，平均年龄 63.1±10.4 岁，65.9%的患者有代偿性肝硬化。1/5 的患者有糖尿病，14.3%的患者肥胖，41.8%的患者有高血压，35.2%的患者吸烟。基线时，平均 IMT 为 0.94±0.29mm，42.8%的患者 IMT≥1mm，42.8%的患者有颈动脉斑块。
所有患者均获得 12 周持续病毒学应答。与基线相比，IMT 在随访时显著降低（0.94±0.29mm 与 0.81±0.27mm，p<0.001）。同样，颈动脉增厚患者的比例从基线到随访也显著降低（42.8%与 17%，p<0.001），而颈动脉斑块无变化（42.8%与 47.8%，p=0.34）。这些结果在根据心血管危险因素和肝病严重程度分层的患者亚组中得到了证实。
DAA 清除 HCV 可改善伴有或不伴有其他代谢危险因素的严重纤维化患者的颈动脉粥样硬化。在长期内，HCV 清除对动脉粥样硬化负担的改善（即主要心血管结局的减少）的影响值得研究。
DAA 清除 HCV 可改善纤维化程度晚期或代偿性肝硬化患者的颈动脉粥样硬化。在根据肝病严重程度和心血管危险因素进行分层后，证实了 IMT 及颈动脉增厚的改善。DAA 清除 HCV 还可改善葡萄糖稳态并增加胆固醇水平。
