应用直接作用抗病毒药物治疗的丙型肝炎肝硬化患者肝脏硬度值变化评估肝细胞癌风险。
Hepatocellular carcinoma risk assessment by the measurement of liver stiffness variations in HCV cirrhotics treated with direct acting antivirals.
机构信息
Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.
出版信息
Dig Liver Dis. 2018 Jun;50(6):573-579. doi: 10.1016/j.dld.2018.02.010. Epub 2018 Feb 27.
BACKGROUND
Direct-acting antivirals (DAA) are an effective treatment for hepatitis C virus infection. However, sustained virologic response (SVR) after DAA treatment does not seem to reduce the risk of hepatocellular carcinoma (HCC) development in these patients. Liver stiffness measurement (LSM) may predict the risk of developing HCC in liver cirrhosis patients.
AIMS
The aim of our study was to evaluate the role of LSM variation as predictor of HCC development in patients treated with DAA.
METHODS
In 139 HCV-related cirrhotic patients, LSM and laboratory tests were carried out at baseline (BL) and at the end of DAA treatment (EOT). Patients were followed for at least 6 months after the EOT. LSM reduction was expressed as Delta LS (∆LS). Cox regression analysis was used to identify prognostic factors for HCC development after DAA.
RESULTS
Median LSM values were significantly reduced from BL to EOT (from 18.6 to 13.8 kPa; p < 0.001). The median ∆LS was -26.7% (IQR: -38.4% -13.6%). During a median follow-up of 15 months after DAA treatment, 20 (14.4%) patients developed HCC. Significant LSM reduction was observed both in patients who developed HCC and in those who did not, but this was significantly lower in the patients who developed HCC (-18.0% vs -28.9% p = 0.005). At multivariate analysis, ∆LS lower than -30%, Child-Turcotte-Pugh-B and history of HCC were independently associated with HCC development.
CONCLUSION
Our results indicate that ∆LS is a useful non-invasive marker for predicting HCC development after DAA treatment.
背景
直接作用抗病毒药物（DAA）是治疗丙型肝炎病毒感染的有效方法。然而，DAA 治疗后的持续病毒学应答（SVR）似乎并不能降低这些患者发生肝细胞癌（HCC）的风险。肝脏硬度测量（LSM）可能预测肝硬化患者发生 HCC 的风险。
目的
本研究旨在评估 LSM 变化作为 DAA 治疗患者发生 HCC 的预测因子的作用。
方法
在 139 例丙型肝炎相关肝硬化患者中，在基线（BL）和 DAA 治疗结束时（EOT）进行 LSM 和实验室检查。患者在 EOT 后至少随访 6 个月。LSM 减少表示为 Delta LS（∆LS）。Cox 回归分析用于确定 DAA 后 HCC 发生的预后因素。
结果
中位 LSM 值从 BL 显著降低到 EOT（从 18.6 降至 13.8 kPa；p < 0.001）。中位 ∆LS 为-26.7%（IQR：-38.4%至-13.6%）。在 DAA 治疗后中位 15 个月的随访期间，20 例（14.4%）患者发生 HCC。在发生 HCC 和未发生 HCC 的患者中均观察到显著的 LSM 降低，但在发生 HCC 的患者中降低更为显著（-18.0%比-28.9%，p = 0.005）。多变量分析显示，∆LS 低于-30%、Child-Turcotte-Pugh-B 和 HCC 史与 HCC 发展独立相关。
结论
我们的研究结果表明，∆LS 是预测 DAA 治疗后 HCC 发展的有用的非侵入性标志物。
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