Internal Medicine Department, Hepatology Division, Zagazig University, Sharkia, Zagazig, 44519, Egypt.
, 40 Mostafa Fouad st, Zagazig, Egypt.
Hepatol Int. 2019 Mar;13(2):165-172. doi: 10.1007/s12072-019-09933-8. Epub 2019 Feb 13.
Medical treatment of decompensated cirrhosis due to hepatitis C virus (HCV) remains a clinical challenge even in the era of direct-acting antiviral drugs (DAAs). We evaluated the efficacy and safety of DAAs in the management of HCV genotype 4-related decompensated cirrhosis.
The study included a treatment group (n = 160) composed of HCV patients with decompensated cirrhosis who received DAAs for 3 months and a matched control group (n = 80) who preferred not to receive DAAs, follow-up was for 24-31 months.
In treatment group; there were improvements in platelet count, albumin, CTP (p = 0.001) and MELD scores (p = 0.03), a significant reduction in the frequency of hepatic encephalopathy (HE). SVR was achieved in 90%. Hepatocellular carcinoma (HCC) developed in 10% (n = 18) within 6.8 ± 2.5 months after DAAs, survival was higher in the treated vs. the control group (28.9 ± 0.95 vs. 11.4 ± 2.2 months, p = 0.001). Liver volume by ultrasound at a cutoff 495 ml was predictive of complications after DAAs therapy mainly HCC and reduced survival with sensitivity 93.2%, specificity 72%.
HCV with decompensated cirrhosis and adequate liver volume had a 90% SVR with improved CTP&MELD and survival.
(NCT03547895).
即使在直接作用抗病毒药物（DAAs）时代，治疗丙型肝炎病毒（HCV）引起的失代偿性肝硬化仍然是一个临床挑战。我们评估了 DAA 在管理 HCV 基因型 4 相关失代偿性肝硬化中的疗效和安全性。
研究包括一个治疗组（n=160），由接受 DAA 治疗 3 个月的 HCV 失代偿性肝硬化患者组成，以及一个匹配的对照组（n=80），他们选择不接受 DAA，随访时间为 24-31 个月。
在治疗组中，血小板计数、白蛋白、CTP（p=0.001）和 MELD 评分（p=0.03）均有改善，肝性脑病（HE）的频率显著降低。SVR 达到 90%。在 DAA 后 6.8±2.5 个月内，HCC 在 10%（n=18）的患者中发展，治疗组的生存率高于对照组（28.9±0.95 vs. 11.4±2.2 个月，p=0.001）。超声测量的肝脏体积在 495ml 截止值预测 DAA 治疗后主要是 HCC 和生存率降低的并发症，具有 93.2%的敏感性和 72%的特异性。
具有代偿性肝硬化和足够肝体积的 HCV 患者的 SVR 为 90%，CTP&MELD 和生存率得到改善。
（NCT03547895）。
