Attia Dina, Deterding Katja, Cornberg Janet, Gebel Michael J, Cornberg Markus, Manns Michael P, Wedemeyer Heiner, Potthoff Andrej
Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
Eur J Gastroenterol Hepatol. 2019 Jan;31(1):67-74. doi: 10.1097/MEG.0000000000001259.
Direct-acting antivirals (DAAs) lead to a high rate of sustained virologic response (SVR) in chronic hepatitis C infection. The aim was to evaluate liver stiffness kinetics, using acoustic radiation force impulse (ARFI) imaging elastography, during and after DAAs in patients who had reached SVR.
A total of 275 consecutive chronic hepatitis C virus-infected patients were included in this longitudinal prospective single-centre study. All patients received DAAs for 8 to 24 weeks, and liver stiffness measurements (LSMs) by ARFI at baseline, at week 4, week 12, week 24, and 24 weeks (SVR24) and 48 weeks (FU48) after the end of treatment were recorded. Transient elastography was performed at baseline and at SVR24.
A decrease in LSM was detected at SVR24 by ARFI and transient elastography (P<0.001 and <0.001, respectively). A continuous gradual decrease in ARFI was observed in patients with cirrhosis versus a nonsignificant change in patients without cirrhosis until FU48 (P<0.001 vs. 0.877, respectively). At SVR24, higher baseline ARFI values (P=0.038) were associated with a decrease in LSM in patients with cirrhosis versus normal international normalization ratio (P=0.003), lower bilirubin (P=0.003), and higher albumin (P=0.007) in patients without cirrhosis. The incidence of liver stiffness decrease from baseline was higher in patients with cirrhosis than in those without cirrhosis (P<0.001), whereas the incidence of liver stiffness progression was more pronounced in advanced than in compensated cirrhosis (P<0.001).
After DAAs in patients with SVR, liver stiffness improves in patients with cirrhosis, whereas non-cirrhotic patients show no true change in liver stiffness. Liver stiffness worsens in patients with advanced liver disease.
直接抗病毒药物（DAA）可使慢性丙型肝炎感染者获得较高的持续病毒学应答（SVR）率。本研究旨在利用声辐射力脉冲（ARFI）成像弹性成像技术评估达到SVR的患者在接受DAA治疗期间及之后的肝脏硬度变化情况。
本纵向前瞻性单中心研究共纳入275例连续的慢性丙型肝炎病毒感染患者。所有患者接受8至24周的DAA治疗，并记录基线、第4周、第12周、第24周以及治疗结束后24周（SVR24）和48周（FU48）时通过ARFI测量的肝脏硬度值（LSM）。在基线和SVR24时进行瞬时弹性成像检查。
通过ARFI和瞬时弹性成像检查发现，在SVR24时LSM下降（分别为P<0.001和<0.001）。与无肝硬化患者直到FU48时无显著变化相比，肝硬化患者的ARFI值持续逐渐下降（分别为P<0.001和0.877）。在SVR24时，肝硬化患者中较高的基线ARFI值（P=0.038）与LSM下降相关，而无肝硬化患者中正常的国际标准化比值（P=0.
