Lanini Simone, Bartolini Barbara, Taibi Chiara, Agresta Alessandro, Garbuglia Anna Rosa, Montaldo Chiara, Pisapia Raffaella, D'Offizi Gianpiero, Scognamiglio Paola, Capobianchi Maria Rosaria, Zumla Alimuddin, Ippolito Giuseppe
National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS- Via Portuense, 292- 00149 Rome, Italy.
Division of Infection and Immunity, University College London, London, UK and 3 NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, UK.
New Microbiol. 2019 Jul;42(3):139-144. Epub 2019 Jul 15.
HCV has been recognized as the cause of chronic hepatitis C (CHC) since 1990. CHC is associated with progressive liver damage and extrahepatic conditions. Direct antiviral agents (DAAs), approved in 2014, have shown effectiveness in eradicating HCV in most patients. However, little is known about the effect of viral eradication on hepatic and extra-hepatic damage. We performed a historical cohort study of patients with HCV-related liver diseases who achieved SVR from March 2015 to October 2016 at INMI Lazzaro Spallanzani liver Unit in Rome (Italy). Repeated measures of glycaemia were analysed through a multilevel analysis framework to assess short time kinetics of blood glucose level at different times after therapy and for different levels of HCV viremia. The analysis included 205 patients. A model assessing temporal kinetics and variation of glycaemia according to HCV viremia provided evidence that blood glucose levels significantly dropped in patients with diabetes achieving SVR. Most of the variations occurred at 3-5 weeks of therapy (-17.96 mg/dL; p<0.001) and in coincidence with HCV clearance (-13.92 mg/dL; p<0.001). A weak, non-statistically significant reduction was observed in normoglycemic patients. Our study provides evidence that DAAs therapy may significantly improve glycaemic control in patients with CHC achieving SVR even when liver diseases are already established.
自1990年以来，丙型肝炎病毒（HCV）已被确认为慢性丙型肝炎（CHC）的病因。CHC与进行性肝损伤和肝外疾病有关。2014年获批的直接抗病毒药物（DAAs）已显示出在大多数患者中根除HCV的有效性。然而，关于病毒根除对肝损伤和肝外损伤的影响知之甚少。我们对2015年3月至2016年10月在意大利罗马的国家传染病研究所拉扎罗·斯帕兰扎尼肝病科实现持续病毒学应答（SVR）的HCV相关肝病患者进行了一项历史性队列研究。通过多水平分析框架对血糖的重复测量进行分析，以评估治疗后不同时间以及不同HCV病毒血症水平下血糖水平的短期动力学。该分析纳入了205名患者。一个根据HCV病毒血症评估血糖时间动力学和变化的模型提供了证据，表明实现SVR的糖尿病患者血糖水平显著下降。大多数变化发生在治疗3 - 5周时（-17.96mg/dL；p<0.001），且与HCV清除同时出现（-13.92mg/dL；p<0.001）。在血糖正常的患者中观察到了微弱的、无统计学意义的降低。我们的研究提供了证据，表明即使肝病已经确立，DAAs治疗仍可能显著改善实现SVR的CHC患者的血糖控制。
Zotero 插件