Barakat Ashraf Abd El-Khalik, Nasr Fatma Mohammad, Metwaly Amna Ahmed, Morsy Sherif, Eldamarawy Mervat
Intensive Care Department (ICU), Theodor Bilharz Research Institute (TBRI), Giza, Egypt.
Gastroenterology and Hepatology Department, Theodor Bilharz Research Institute (TBRI), Giza, Egypt.
Egypt Heart J. 2017 Jun;69(2):139-147. doi: 10.1016/j.ehj.2016.10.004. Epub 2016 Nov 3.
Chronic Hepatitis C virus (HCV) infection and liver cirrhosis may be associated with atherosclerosis and coronary artery disease (CAD). There are two phases to atherosclerosis, Subclinical and Clinical. Assessment of atherosclerosis may be started at its Subclinical phase by the evaluation of Epicardial Fat Thickness (EpFT) and Carotid Intima Thickness (CIMT).
The aim of the study was to evaluate Clinical and Subclinical atherosclerosis in chronic HCV patients with and without liver cirrhosis by evaluating CIMT and EpFT and correlating the results with Child-Pugh functional scoring of cirrhosis as well as with ultrasound and laboratory parameters that define the severity of liver disease.
This study involved 64 chronic HCV patients that were divided into two groups: 24 patients and 40 patients in addition to 20 apparently healthy volunteers serving as All of the 84 subjects were subjected to the following: Clinical evaluation; Routine Laboratory Evaluation (CBC, Liver Function Tests, Renal Function Tests, Serum electrolytes, Cholesterol, Triglycerides, HBs antigen and HCV antibody); ECG; Abdominal ultrasound; Echocardiographic evaluation of segmental wall motion abnormalities and EpFT and B-Mode Carotid ultrasonography for evaluation of CIMT.
In the cirrhotic HCV group, the CIMT and EpFT were both significantly increased [Compared to control group ( = 0.000), compared to the non-cirrhotic HCV group ( = 0.000)]. In the non-cirrhotic HCV group, the CIMT and EpFT were both significantly increased compared to the control group with a -value of 0.003 for CIMT and 0.048 for EpFT. The CIMT and EpFT were also positively correlated with each other ( = 0.456, = 0.001). There was a statistically significant increase in the EpFT and CIMT in Child class B patients compared to Child class A ( = 0.007 for CIMT and = 0.028 for EpFT) and in Child class C patients compared to Child class B patients ( = 0.001 for CIMT and 0.005 for EpFT). CIMT and EpFT were correlated positively with AST ( = 0.385, = 0.002 for CIMT, and = 0.379, = 0.003 for EpFT), Total Bilirubin ( = 0.378, = 0.003 for CIMT, and = 0.384, = 0.002 for EpFT), INR% ( = 0.456, = 0.001 for CIMT, and = 0.384, = 0.001 for EpFT), CRP ( = 0.378, = 0.003 for CIMT, and = 0.386, = 0.002 for EpFT), spleen span ( = 0.417, = 0.001 for CIMT, and = 0.437, = 0.001 for EpFT) and portal Vein Diameter ( = 0.372, = 0.003 for CIMT, and = 0.379, = 0.003 for EpFT). CIMT and EpFT were correlated negatively with Albumin ( = -0.379, = 0.003 for CIMT, and = -0.370, = 0.003 for EpFT), platelets count ( = -0.382, = 0.002 for CIMT, and = 0.378, = 0.003 for EpFT) and Liver Span ( = -0.433, = 0.001 for CIMT, and = -0.424, = 0.001 for EpFT).
EpFT and CIMT significantly increased in chronic hepatitis C virus patients especially in those with cirrhosis and closely correlated with each other. Their thickness also correlated with the Child-Pugh functional scoring of cirrhosis as well as with ultrasound and laboratory parameters that define the severity of liver disease.The echocardiographic assessment of EpFT and the carotid Doppler assessment of CIMT may provide appropriate and simple screening markers for subclinical atherosclerosis and cardiovascular risk in chronic HCV patients with and without cirrhosis.
慢性丙型肝炎病毒（HCV）感染和肝硬化可能与动脉粥样硬化和冠状动脉疾病（CAD）有关。动脉粥样硬化有两个阶段，亚临床阶段和临床阶段。可通过评估心外膜脂肪厚度（EpFT）和颈动脉内膜厚度（CIMT）在动脉粥样硬化的亚临床阶段开始进行评估。
本研究的目的是通过评估CIMT和EpFT，并将结果与肝硬化的Child-Pugh功能评分以及定义肝病严重程度的超声和实验室参数相关联，来评估有无肝硬化的慢性HCV患者的临床和亚临床动脉粥样硬化。
本研究纳入64例慢性HCV患者，分为两组：24例患者和40例患者，另外20名明显健康的志愿者作为对照。所有84名受试者均接受以下检查：临床评估；常规实验室评估（血常规、肝功能检查、肾功能检查、血清电解质、胆固醇、甘油三酯、乙肝抗原和丙肝抗体）；心电图；腹部超声；节段性室壁运动异常和EpFT的超声心动图评估以及用于评估CIMT的B型颈动脉超声检查。
在肝硬化HCV组中，CIMT和EpFT均显著增加[与对照组相比（P = 0.000），与非肝硬化HCV组相比（P = 0.000）]。在非肝硬化HCV组中，与对照组相比，CIMT和EpFT均显著增加，CIMT的P值为0.003，EpFT的P值为0.048。CIMT和EpFT也呈正相关（r = 0.456，P = 0.001）。与Child A级患者相比，Child B级患者的EpFT和CIMT有统计学显著增加（CIMT的P = 0.007，EpFT的P = 0.028），与Child B级患者相比，Child C级患者的CIMT和EpFT也有增加（CIMT的P = 0.001，EpFT的P = 0.005）。CIMT和EpFT与AST呈正相关（CIMT的r = 0.385，P = 0.002，EpFT的r = 0.379，P = 0.003）、总胆红素（CIMT的r = 0.378，P = 0.003，EpFT的r = 0.384，P = 0.002）、INR%（CIMT的r = 0.456，P = 0.001，EpFT的r = 0.384，P = 0.001）、CRP（CIMT的r = 0.378，P = 0.003，EpFT的r = 0.386，P = 0.002）、脾径（CIMT的r = 0.417，P = 0.001，EpFT的r = 0.437，P = 0.001）和门静脉直径（CIMT的r = 0.372，P = 0.003，EpFT的r = 0.379, P = 0.003）。CIMT和EpFT与白蛋白呈负相关（CIMT的r = -0.379，P = 0.003，EpFT的r = -0.370，P = 0.003）、血小板计数（CIMT的r = -0.382，P = 0.002，EpFT的r = 0.378，P = 0.003）和肝径（CIMT 的r = -0.433，P = 0.001，EpFT的r = -0.424，P = 0.001）。
慢性丙型肝炎病毒患者，尤其是肝硬化患者，EpFT和CIMT显著增加，且彼此密切相关。它们的厚度也与肝硬化的Child-Pugh功能评分以及定义肝病严重程度的超声和实验室参数相关。对EpFT的超声心动图评估和对CIMT的颈动脉多普勒评估可为有无肝硬化的慢性HCV患者的亚临床动脉粥样硬化和心血管风险提供合适且简单的筛查标志物。
