直接作用抗病毒药物对丙型肝炎病毒相关慢性肝病中血小板相关免疫球蛋白 G 和血小板减少症的影响。

Effect of direct-acting antivirals on platelet-associated immunoglobulin G and thrombocytopenia in hepatitis C virus-related chronic liver disease.

机构信息

Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.

出版信息

Liver Int. 2019 Sep;39(9):1641-1651. doi: 10.1111/liv.14120. Epub 2019 May 24.

DOI:10.1111/liv.14120

PMID:31009141

Abstract

BACKGROUND & AIMS: Hepatitis C virus (HCV) infection has been known to cause various extrahepatic autoimmune disorders. The prevalence of platelet-associated immunoglobulin G (PA-IgG) has been high in patients with HCV infection. Because thrombocytopenia in HCV-related liver diseases is a notable problem, we performed prospective study on the effect of direct-acting antivirals (DAAs) treatment on PA-IgG and platelet count.

METHODS

A total of 215 patients with HCV-related liver disease were enrolled in this study. The patients who discontinued DAAs or did not undergo adequate laboratory examinations and who did not achieve sustained virologic response were excluded and finally a total of 187 patients were investigated.

RESULTS

A total of 171 patients (91.4%) were PA-IgG positive (>46 ng/10 cells) before starting DAAs (baseline). The PA-IgG level elevation was significantly correlated with higher liver inflammation and fibrosis markers (P < 0.05) and lower platelet count (P = 0.000019). The platelet count of the patients with low PA-IgG titer tended to be higher at baseline, end of treatment (EOT), and at 12 and 24 weeks after EOT. The platelet count increased at EOT (P < 0.05) and 24 weeks after EOT (P < 0.01). The PA-IgG levels were significantly decreased at EOT, 12 and 24 weeks after EOT (P < 0.01). Multiple regression analysis found that only platelet count at baseline was closely associated with negative conversion of PA-IgG at 24 weeks after EOT (P = 0.004).

CONCLUSIONS

Eradication of HCV by DAAs treatment successfully decreased PA-IgG level and increased platelet count.

摘要

背景与目的

丙型肝炎病毒（HCV）感染已知可引起各种肝外自身免疫性疾病。丙型肝炎病毒感染者血小板相关免疫球蛋白 G（PA-IgG）的患病率较高。由于丙型肝炎相关肝病中的血小板减少是一个显著问题，我们对直接作用抗病毒药物（DAA）治疗对 PA-IgG 和血小板计数的影响进行了前瞻性研究。

方法

本研究共纳入 215 例丙型肝炎相关肝病患者。排除停止 DAA 治疗或未进行充分实验室检查且未达到持续病毒学应答的患者，最终共纳入 187 例患者进行研究。

结果

共有 171 例（91.4%）患者在开始 DAA 治疗前（基线时）PA-IgG 阳性（>46ng/10 细胞）。PA-IgG 水平升高与较高的肝炎症和纤维化标志物显著相关（P<0.05），与较低的血小板计数显著相关（P=0.000019）。低 PA-IgG 滴度患者的血小板计数在基线时、治疗结束时（EOT）以及 EOT 后 12 和 24 周时往往较高。EOT 时血小板计数增加（P<0.05），EOT 后 24 周时血小板计数增加（P<0.01）。EOT、EOT 后 12 和 24 周时，PA-IgG 水平显著降低（P<0.01）。多元回归分析发现，只有基线时的血小板计数与 EOT 后 24 周时 PA-IgG 阴性转换密切相关（P=0.004）。