Department of Gastroenterology and Hepatology. Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain.
Department of Gastroenterology and Hepatology. Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain.
Ann Hepatol. 2019 May-Jun;18(3):429-433. doi: 10.1016/j.aohep.2018.07.004. Epub 2019 Apr 17.
To determine the prevalence of minimal hepatic encephalopathy(MHE) in patients with liver cirrhosis (LC) due to hepatitis C virus (HCV) infection and to evaluate the impact of sustained viral response (SVR) on MHE.
We performed a prospective study using MHE screening and follow-up on patients with HCV and LC. The patients were evaluated at the beginning of treatment and 24 weeks after treatment.
64 patients were included. 51.6% were male, the median age was 62 years, Child-Pugh classification A/B/C 93.8%/4.7%/1.6% and median MELD was 8.3. Prior hydropic decompensation was present in 11 patients. Median values of liver stiffness, as measured by transient elastography (TE) were 22.8kPa. Indirect signs of portal hypertension (PH) were present in 53.1% of patients, with a mean of 11.9mmHg among the ones with a measurement of the hepatic venous pressure gradient. The prevalence of MHE before treatment was 26.6%. After treatment, 98.4% of patients achieved SVR. The presence of MHE at 24 weeks post-treatment had an statistically significant association with the presence of pre-treatment MHE (80% vs. 21.6%; p<0.01), higher MELD scores at 24-weeks post-treatment (9.8 vs. 8; p=0.02), higher Child-Pugh scores at 24-weeks post-treatment (p=0.04), higher baseline INR levels (1.4 vs. 1.1; p<0.001) and with the presence of indirect signs of PH (100% vs. 47.1%; p=0.02). During follow-up, those patients without MHE at 24 weeks post-treatment had a higher probability of experiencing an improvement in post-treatment TE (80.9% vs. 40%, p=0.04).
We found that SVR may lead to MHE resolution in a considerable proportion of patients, which has potential implications for disease prognosis.
确定丙型肝炎病毒（HCV）感染导致的肝硬化（LC）患者中轻微肝性脑病（MHE）的患病率，并评估持续病毒应答（SVR）对 MHE 的影响。
我们对 HCV 和 LC 患者进行了前瞻性研究，包括 MHE 筛查和随访。患者在治疗开始时和治疗后 24 周进行评估。
共纳入 64 例患者，其中 51.6%为男性，中位年龄为 62 岁，Child-Pugh 分级 A/B/C 分别为 93.8%/4.7%/1.6%，MELD 中位数为 8.3。11 例患者存在既往水肿性失代偿。瞬时弹性成像（TE）测量的肝硬度中位数为 22.8kPa。53.1%的患者存在间接门静脉高压（PH）征象，肝静脉压力梯度测量值的平均 PH 为 11.9mmHg。治疗前 MHE 的患病率为 26.6%。治疗后，98.4%的患者达到 SVR。治疗后 24 周时 MHE 的存在与治疗前 MHE 的存在（80%与 21.6%；p<0.01）、治疗后 24 周时 MELD 评分较高（9.8 与 8；p=0.02）、治疗后 24 周时 Child-Pugh 评分较高（p=0.04）、较高的基线 INR 水平（1.4 与 1.1；p<0.001）和间接 PH 征象的存在（100%与 47.1%；p=0.02）有统计学显著关联。在随访期间，24 周后无 MHE 的患者 TE 治疗后改善的可能性更高（80.9%与 40%，p=0.04）。
我们发现 SVR 可能导致相当一部分患者的 MHE 缓解，这对疾病预后有潜在影响。
Zotero 插件