Miyasaka Akio, Yoshida Yuichi, Suzuki Akiko, Ueda Hironobu, Morino Yoshihiro, Takikawa Yasuhiro
Division of Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, 020-8505, Japan.
Division of Cardiology, Department of Internal Medicine, Iwate Medical University School of Medicine, Morioka, Japan.
Clin J Gastroenterol. 2020 Feb;13(1):90-96. doi: 10.1007/s12328-019-01016-3. Epub 2019 Jul 10.
A 44-year-old woman with chronic hepatitis C virus (HCV) infection was referred by a primary care doctor and admitted to our hospital because of worsening dyspnea on exertion and right atrial and ventricular enlargement. The patient was diagnosed with pulmonary arterial hypertension (PAH) associated with portal hypertension induced by chronic HCV infection. This diagnosis was based on a cardiological examination and findings related to liver cirrhosis with portal hypertension. After the prescription of anti-PAH medicine and a slight improvement in her respiratory symptoms, 12-week direct-acting antiviral (DAA) treatment for HCV was started. Serum HCV RNA levels rapidly decreased and HCV elimination was confirmed 24 weeks after completing DAA treatment. Before confirmation of a sustained virological response at 24 weeks after completing DAA treatment, a remarkable improvement in her cardiac markers was found in a right heart catheter study. This study was performed 6 weeks after the end of DAA administration. Therefore, we considered that HCV infection was involved in the development of PAH and that elimination of HCV by interferon-free treatment was important for this patient.
一名44岁的慢性丙型肝炎病毒（HCV）感染女性患者由一名初级保健医生转诊至我院，因劳力性呼吸困难加重以及右心房和心室增大入院。该患者被诊断为与慢性HCV感染引起的门静脉高压相关的肺动脉高压（PAH）。这一诊断基于心脏检查以及与肝硬化伴门静脉高压相关的检查结果。在开具抗PAH药物且患者呼吸症状稍有改善后，开始了为期12周的HCV直接抗病毒（DAA）治疗。血清HCV RNA水平迅速下降，在完成DAA治疗24周后确认HCV已清除。在完成DAA治疗24周确认获得持续病毒学应答之前，在一项右心导管检查中发现其心脏标志物有显著改善。这项检查在DAA给药结束6周后进行。因此，我们认为HCV感染参与了PAH的发生发展，并且对该患者而言，通过无干扰素治疗清除HCV非常重要。
