丙型肝炎病毒治疗期间血脂升高：病毒作用还是药物影响？

INCREASE OF LIPIDS DURING HCV TREATMENT: VIRUS ACTION OR MEDICATION?

作者信息

Andrade Vanessa Gutierrez de, Yamashiro Fabio da Silva, Oliveira Cassio Vieira, Kurozawa Leticia Lastória, Moreira Alecsandro, Silva Giovanni Faria

机构信息

Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP), Campus Botucatu, Faculdade de Medicina, Departamento de Clínica Médica, Botucatu, SP, Brasil.

出版信息

Arq Gastroenterol. 2018 Apr-Jun;55(2):184-187. doi: 10.1590/S0004-2803.201800000-33.

DOI:10.1590/S0004-2803.201800000-33

PMID:30043871

Abstract

BACKGROUND

The interaction between serum lipids and C virus infection is well known, as are serum lipid levels in the Peg-IFN / RBV-based treatment. However, with direct action antivirals (DAAs) this behavior is still unclear.

OBJECTIVE

To compare serum lipids levels between patients treated with Peg-IFN/RBV and DAAs and to evaluate lipids in sustained virological response (SVR) with DAAs.

METHODS

Retro prospective study comparing the behavior of total cholesterol (TC), low-density lipoprotein (LDL) and triglycerides (TG) serum levels during treatment with DAAs (G-DAAs) and a control historic group Peg-IFN/RBV (G-PR). Coorte, prospective study, to study the behavior of lipids in the SVR with DAAs. Data were collected at the beginning of treatment (baseline: t-base) and at week 12 of treatment (t-12) for G-DAAs and at week 24 (t-24) for G-PR, groups. In the cohort evaluation, the samples at t-base and at week 12 after the end of treatment (t-SVR). Delta lipids: difference between lipids in t-12 / t-24 minus t-base for comparison between G-PR and G-AADs groups and t-SVR minus t-base for lipid analysis in SVR. Analysis with Kruskal Wallis and Wilcoxon tests to compare the delta lipids of the groups. The P value was 0.05.

RESULTS

In the assessment between G-PR and G-DAAs groups, we included 63 and 121 patients, respectively. The groups did not differ one from the other (BMI, sex, genotype, fibrosis, total cholesterol, LDL, and TG) except by age (50.38±10.44 vs 56±9.69, P=0.0006). We observed a decrease in levels of TC and LDL and an increase in TG, in G-PR, and in G-DAAs the opposite (Δ TC -13.9±34.5 vs 4.12±34.3 P=0.0005, Δ LDL -7.16±32 vs 10.13±29.92, P=0.003, Δ TG 4.51±53.7 vs -8.24±49.93, P=0.0025). In the coorte analysis, we included 102 patients, 70% men and 56% F4, 95 of them reached SVR. We observed an increase of TC and LDL and a decrease of TG in both groups (SVR and non SVR), with no statistical difference (Δ TC P=0.68; Δ LDL P=0.69; Δ TG P=0.43). We did not find significant difference in delta evaluation by genotype 1 and 3 (Δ TC +29.7±40.2 vs +13.4±30.3, P=0.06; Δ LDL +21.4±28.6 vs +16.6±31.3, P=0.41; Δ TG -3.6±60.6 vs -0.7±40, P=0.91).

CONCLUSION

Serum lipids level differed during treatment with Peg-IFN and DAAs. Treatment with DAAs was associated with an increase of TC and LDL and a decrease of TG, independently of SVR.

摘要

背景

血清脂质与丙型肝炎病毒感染之间的相互作用已为人熟知，基于聚乙二醇干扰素/利巴韦林的治疗中的血清脂质水平也是如此。然而，对于直接作用抗病毒药物（DAA），这种情况仍不清楚。

目的

比较接受聚乙二醇干扰素/利巴韦林和DAA治疗的患者的血清脂质水平，并评估DAA治疗获得持续病毒学应答（SVR）患者的脂质情况。

方法

回顾性前瞻性研究，比较DAA（泛基因型DAA，G-DAA）治疗组与历史对照聚乙二醇干扰素/利巴韦林（G-PR）组治疗期间总胆固醇（TC）、低密度脂蛋白（LDL）和甘油三酯（TG）的血清水平变化。前瞻性队列研究，研究DAA治疗获得SVR患者的脂质变化情况。G-DAA组在治疗开始时（基线：t-base）和治疗第12周（t-12）收集数据，G-PR组在治疗第24周（t-24）收集数据。在队列评估中，在t-base和治疗结束后第12周（t-SVR）采集样本。脂质变化量：t-12/t-24时的脂质水平减去t-base时的脂质水平，用于比较G-PR组和G-DAA组；t-SVR时的脂质水平减去t-base时的脂质水平用于分析SVR中的脂质情况。采用Kruskal Wallis检验和Wilcoxon检验分析比较各组的脂质变化量。P值设定为0.05。

结果

在G-PR组和G-DAA组的评估中，分别纳入了63例和121例患者。除年龄外（50.38±10.44对56±9.69，P = 0.0006），两组在其他方面（BMI、性别、基因型、纤维化程度、总胆固醇、LDL和TG）无差异。我们观察到，G-PR组中TC和LDL水平下降，TG水平升高，而G-DAA组情况相反（ΔTC -13.9±34.5对4.12±34.3，P = 0.0005；ΔLDL -7.16±32对10.13±29.92，P = 0.003；ΔTG 4.51±53.7对-8.24±49.93，P = 0.0025）。在队列分析中，纳入了102例患者，其中70%为男性，56%为F4级，95例患者获得SVR。我们观察到两组（SVR组和非SVR组）的TC和LDL水平升高，TG水平降低，但无统计学差异（ΔTC P = 0.68；ΔLDL P = 0.69；ΔTG P = 0.43）。按基因型1和3分析脂质变化量未发现显著差异（ΔTC +29.7±40.2对+13.4±30.3，P = 0.06；ΔLDL +21.4±28.6对+16.6±31.3，P = 0.41；ΔTG -3.6±60.6对-0.7±40，P = 0.91）。