Hsu Wei-Fan, Lai Hsueh-Chou, Su Wen-Pang, Lin Chia-Hsin, Chuang Po-Heng, Chen Sheng-Hung, Chen Hung-Yao, Wang Hung-Wei, Huang Guan-Tarn, Peng Cheng-Yuan
Division of Hepatogastroenterology, Department of Internal Medicine, China Medical University Hospital, No. 2, Yuh-Der Road, 40447, Taichung, Taiwan.
Graduate Institute of Biomedical Science, China Medical University, 40442, Taichung, Taiwan.
BMC Gastroenterol. 2019 Apr 27;19(1):63. doi: 10.1186/s12876-019-0973-5.
Studies on temporal changes in noninvasive fibrosis indices and liver stiffness measurement (LSM) in patients with chronic hepatitis C (CHC) treated with direct-acting antiviral agents (DAAs) are limited.
We retrospectively enrolled consecutive patients with CHC who had received DAAs.
In total, we recruited 395 consecutive patients, of which 388 (98.2%) achieved a sustained virologic response (SVR) at 12 weeks after therapy. In patients who received DAA therapy and achieved SVR 12 weeks after therapy (n = 388), the median aspartate aminotransferase/platelet ratio index (APRI) value decreased from 1.19 (0.62-2.44) at baseline to 0.50 (0.32-0.95), 0.51 (0.31-0.92), 0.48 (0.31-0.88), and 0.52 (0.33-0.92) at week 2, week 4, end of therapy, and PW12, respectively (all P < 0.001). The median FIB-4 value decreased from 2.88 (1.56-5.60) at baseline to 2.10 (1.30-3.65), 2.15 (1.30-3.65), 2.11 (1.37-3.76), and 2.22 (1.45-3.82) at week 2, week 4, end of therapy, and PW12, respectively (all P < 0.001). The median alanine aminotransferase level significantly decreased from week 2 until PW12 (all P < 0.001). The platelet count significantly increased from 2 weeks after DAA therapy initiation until PW12 (all P < 0.001); however, the magnitude of changes in the platelet count was low. In patients with paired LSMs obtained using acoustic radiation force impulse elastography at baseline and PW12 (n = 199), the median LSM decreased from 1.78 (1.25-2.30) m/s at baseline to 1.38 (1.14-1.88) m/s at PW12 (P < 0.001).
Noninvasive fibrosis indices, namely APRI and FIB-4, exhibited a rapid and sustained decline from week 2 until PW12 in patients with CHC who achieved SVR to DAA therapy. The rapid decline in APRI and FIB-4 values might mainly result from improvement in necroinflammation.
关于接受直接作用抗病毒药物（DAA）治疗的慢性丙型肝炎（CHC）患者非侵入性纤维化指标和肝脏硬度测量（LSM）的时间变化研究有限。
我们回顾性纳入了连续接受DAA治疗的CHC患者。
总共，我们连续招募了395例患者，其中388例（98.2%）在治疗后12周实现了持续病毒学应答（SVR）。在接受DAA治疗并在治疗后12周实现SVR的患者（n = 388）中，天冬氨酸氨基转移酶/血小板比率指数（APRI）的中位数从基线时的1.19（0.62 - 2.44）分别降至治疗第2周时的0.50（0.32 - 0.95）、第4周时的0.51（0.31 - 0.92）、治疗结束时的0.48（0.31 - 0.88）以及治疗后12周时的0.52（0.33 - 0.92）（所有P < 0.001）。FIB - 4的中位数从基线时的2.88（1.56 - 5.60）分别降至治疗第2周时的2.10（1.30 - 3.65）、第4周时的2.15（1.30 - 3.65）、治疗结束时的2.11（1.37 - 3.76）以及治疗后12周时的2.22（1.45 - 3.82）（所有P < 0.001）。丙氨酸氨基转移酶水平从中治疗第2周直到治疗后12周显著下降（所有P < 0.001）。血小板计数从开始DAA治疗后2周直到治疗后12周显著增加（所有P < 0.001）；然而，血小板计数的变化幅度较小。在基线和治疗后12周使用声辐射力脉冲弹性成像获得配对LSM的患者（n = 199）中，LSM的中位数从基线时的1.78（1.25 - 2.30）m/s降至治疗后12周时的1.38（1.14 - 1.88）m/s（P < 0.001）。
在接受DAA治疗实现SVR的CHC患者中，非侵入性纤维化指标APRI和FIB - 4从治疗第2周直到治疗后12周呈现快速且持续的下降。APRI和FIB - 4值的快速下降可能主要源于坏死性炎症的改善。
