Romano John, Sims Omar T, Richman Joshua, Guo Yuqi, Matin Tasnia, Shoreibah Mohamed, Kommineni Vishnu, Venkata Krishna, Massoud Omar I
Department of Internal Medicine, School of Medicine University of Alabama at Birmingham Birmingham Alabama USA.
Department of Social Work, College of Arts and Sciences University of Alabama at Birmingham Birmingham Alabama USA.
JGH Open. 2018 Sep 19;2(6):317-321. doi: 10.1002/jgh3.12091. eCollection 2018 Dec.
The aims of this study were to examine changes in the proportion of decompensated hepatitis C virus (HCV) cirrhosis patients with ascites, hepatic encephalopathy, and variceal bleeding at pretreatment compared to 3 and 12 months post-sustained virological response (SVR) and to compare pretreatment and post-SVR model of end-stage liver disease and Child-Pugh scores and alpha-fetoprotein levels.
Electronic medical records of 64 decompensated HCV cirrhosis patients who received direct-acting antivirals were reviewed. The McNemar-Bowker test and the Wilcoxon-Signed Rank test were used to compare patient outcomes.
Ascites was resolved in 29% of patients 3 months post-SVR (65% 36%, < 0.01) and in 35% of patients 12 months post-SVR (65% 30%, = 0.07). Hepatic encephalopathy was resolved in 54% of patients 3 months post-SVR (70% 16%, < 0.01) and in 48% of patients 12 months post-SVR (70% 22% = 0.03). Variceal bleeding was absent in 32% of patients 3 months post-SVR (35% 3%, < 0.01) and in 27% of patients 12 months post-SVR (35% 8%, < 0.01). Alpha-fetoprotein levels were significantly reduced post-SVR, but model of end-stage liver disease and Child-Pugh scores were not.
Decompensated HCV cirrhosis patients who achieved SVR with direct-acting antiviral treatment had significant reductions in manifestations of hepatic decompensation sustainable up to 1 year post-SVR.
本研究旨在探讨失代偿期丙型肝炎病毒（HCV）肝硬化患者腹水、肝性脑病和静脉曲张出血比例在治疗前与持续病毒学应答（SVR）后3个月及12个月时的变化，并比较治疗前与SVR后的终末期肝病模型、Child-Pugh评分及甲胎蛋白水平。
回顾了64例接受直接抗病毒药物治疗的失代偿期HCV肝硬化患者的电子病历。采用McNemar-Bowker检验和Wilcoxon符号秩检验比较患者的预后。
SVR后3个月时，29%的患者腹水消退（65%对36%，P<0.01）；SVR后12个月时，35%的患者腹水消退（65%对30%，P=0.07）。SVR后3个月时，54%的患者肝性脑病得到缓解（70%对16%，P<0.01）；SVR后12个月时，48%的患者肝性脑病得到缓解（70%对22%，P=0.03）。SVR后3个月时，32%的患者未发生静脉曲张出血（35%对3%，P<0.01）；SVR后12个月时，27%的患者未发生静脉曲张出血（35%对8%，P<0.01）。SVR后甲胎蛋白水平显著降低，但终末期肝病模型和Child-Pugh评分未降低。
接受直接抗病毒治疗且达到SVR的失代偿期HCV肝硬化患者，肝失代偿表现显著减轻，且可持续至SVR后1年。
