血清甲胎蛋白的临床影响及其与接受直接作用抗病毒药物治疗的丙型肝炎病毒患者肝纤维化变化的关系。
Clinical impact of serum α-fetoprotein and its relation on changes in liver fibrosis in hepatitis C virus patients receiving direct-acting antivirals.
机构信息
Department of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University.
Department of Endemic Medicine, Faculty of Medicine, Helwan University.
出版信息
Eur J Gastroenterol Hepatol. 2019 Sep;31(9):1129-1134. doi: 10.1097/MEG.0000000000001400.
BACKGROUND
α-Fetoprotein (AFP) is used widely as a serological marker for hepatocellular carcinoma. However, the AFP value is elevated in chronic hepatitis C virus (HCV) patients without hepatocellular carcinoma. Yet, data on the impact of direct-acting antiviral agents (DAAs) therapy on AFP levels after viral eradication are still lacking.
AIM
The aim of this study was to elucidate the changes in the serum AFP level in chronic hepatitis C patients treated with DAA-based therapy and their relation to response and liver fibrosis parameters.
PATIENTS AND METHODS
A total of 456 chronic HCV patients who received different DAAs-based treatment regimens were enrolled. Laboratory data including serum AFP, transient elastography values, and fibrosis scores were recorded at baseline and sustained virological response at 24 weeks after treatment (SVR24). The outcome was the changes in the AFP level from baseline to SVR24 and its relation to changes in liver fibrosis parameters at SVR24 using Spearman's rank correlation test.
RESULTS
Overall, 96.9% of enrolled patients were responders. A statistically significant improvement in serum transaminases, albumin, transient elastography values, and fibrosis scores at SVR24 was reported. The AFP level was significantly decreased from a median (interquartile range) of 6 (3.2-10.8) ng/ml before DAAs to 4 (2.3-6) ng/ml at SVR24 (P < 0.0001). Only 22.6% of patients showed an increase in the AFP level after treatment. On multivariate analysis, the only independent baseline variable associated with an increase in the AFP level after treatment was baseline AFP (odds ratio: 0.95, 95% confidence interval: 0.91-0.99, P = 0.02). There is a significant correlation between changes in AFP and liver fibrosis parameters at SVR24.
CONCLUSION
DAAs-based regimens are a highly efficient antiviral therapy for chronic hepatitis C patients that resulted in improvements in the serum AFP level.
背景
甲胎蛋白（AFP）被广泛用作肝细胞癌的血清标志物。然而，慢性丙型肝炎病毒（HCV）患者的 AFP 值升高，而无肝细胞癌。然而，关于病毒清除后直接作用抗病毒药物（DAA）治疗对 AFP 水平影响的数据仍然缺乏。
目的
本研究旨在阐明 DAA 为基础的治疗方案治疗慢性丙型肝炎患者的血清 AFP 水平变化及其与反应和肝纤维化参数的关系。
患者和方法
共纳入 456 例接受不同 DAA 治疗方案的慢性 HCV 患者。记录基线时和治疗 24 周后持续病毒学应答（SVR24）时的实验室数据，包括血清 AFP、瞬时弹性成像值和纤维化评分。结局是从基线到 SVR24 时 AFP 水平的变化及其与 SVR24 时肝纤维化参数变化的关系，采用 Spearman 秩相关检验。
结果
总体而言，96.9%的患者为应答者。报道 SVR24 时血清转氨酶、白蛋白、瞬时弹性成像值和纤维化评分均有显著改善。DAA 治疗前 AFP 中位数（四分位距）为 6（3.2-10.8）ng/ml，治疗后 SVR24 时 AFP 中位数为 4（2.3-6）ng/ml，差异有统计学意义（P<0.0001）。治疗后仅 22.6%的患者 AFP 水平升高。多变量分析显示，治疗后 AFP 水平升高的唯一独立基线变量是基线 AFP（比值比：0.95，95%置信区间：0.91-0.99，P=0.02）。SVR24 时 AFP 变化与肝纤维化参数之间存在显著相关性。
结论
DAA 为基础的方案是慢性丙型肝炎患者高效抗病毒治疗方法，可改善血清 AFP 水平。
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