Department of Internal Medicine I, Goethe University Hospital, Frankfurt, Germany.
Center for HIV and Hepatogastroenterology, Düsseldorf, Germany.
J Viral Hepat. 2020 Jul;27(7):690-698. doi: 10.1111/jvh.13280. Epub 2020 Mar 9.
The impact of direct-acting antiviral (DAA) therapies on fibrosis regression remains uncertain. In the current study, we prospectively evaluated dynamics of liver stiffness by transient elastography (TE) in patients with chronic HCV infection receiving DAA-based treatment. Patients (260) were enrolled in the German Hepatitis C-Registry (DHC-R), a national multicentre real-world cohort. Liver stiffness (LS) was assessed at baseline, end of treatment (EOT) and 24 weeks after EOT (FU24) by TE. Biochemical, virological and clinical data were obtained in parallel. In patients with SVR, there was a significant improvement of LS between baseline (median [range], 8.6 [1.7-73.5] kPa) and FU24 (7.9 [1.7-75 kPa]; P < .0001) as well as between EOT (8.4 [1.7-73.5 kPa]) and FU24 [P < .0001]. Stratified by fibrosis stage, patients classified into F4 had higher magnitude of LS reduction between BL (median [range], 25.1 [13.5-73.5] kPa) and FU24 (21.5 [3.1-75] kPa; P = .002) compared to those with F2-F3 (8.9 [7.1-12.4] kPa and 8.8 [4.2-29.1]; P = .060) or F0-F1 (5.3 [1.7-7] kPa and 5.2 [1.7-7.7]; P = .064). In cirrhotic patients, low platelets were significantly associated with lack of liver stiffness improvement, both at EOT (P = .018) and at FU24 (P = .012). LS significantly correlated with ALT (r = .371), AST (r = .552), platelets (r = -.499), GGT (r = .250), bilirubin (r = .230), APRI score (r = .512), FIB-4 score (r = .517) and FORNS index (r = .562); P < .0001. Liver elastography improved significantly in our real-world cohort after DAA-based therapy. As LS correlates similarly with transaminase levels and serum fibrosis markers, it might reflect both reduction of necroinflammation and fibrosis regression.
直接作用抗病毒 (DAA) 治疗对纤维化消退的影响仍不确定。在目前的研究中，我们前瞻性地评估了接受 DAA 治疗的慢性 HCV 感染患者通过瞬时弹性成像 (TE) 的肝硬度动态变化。患者（260 名）被纳入德国丙型肝炎注册处（DHC-R），这是一个全国性的多中心真实世界队列。通过 TE 在基线、治疗结束时（EOT）和 EOT 后 24 周（FU24）评估肝硬度（LS）。同时获得生化、病毒学和临床数据。在 SVR 患者中，LS 从基线（中位数[范围]，8.6 [1.7-73.5] kPa）到 FU24（7.9 [1.7-75 kPa]；P <.0001）以及 EOT（8.4 [1.7-73.5 kPa]）到 FU24 均有显著改善[P <.0001]。按纤维化分期分层，F4 期患者的 LS 降低幅度高于 F2-F3 期（BL 中位数[范围]，25.1 [13.5-73.5] kPa 与 FU24 中位数[范围]，21.5 [3.1-75] kPa；P =.002）或 F0-F1 期（8.9 [7.1-12.4] kPa 和 8.8 [4.2-29.1] kPa；P =.060）或 F0-F1 期（5.3 [1.7-7] kPa 和 5.2 [1.7-7.7] kPa；P =.064）。在肝硬化患者中，低血小板计数与 EOT 时（P =.018）和 FU24 时（P =.012）的肝硬度改善缺乏显著相关。LS 与 ALT（r =.371）、AST（r =.552）、血小板（r =-.499）、GGT（r =.250）、胆红素（r =.230）、APRI 评分（r =.512）、FIB-4 评分（r =.517）和 FORNS 指数（r =.562）显著相关；P <.0001。在我们的真实世界队列中，DAA 治疗后肝弹性成像显著改善。由于 LS 与转氨酶水平和血清纤维化标志物的相关性相似，它可能反映了坏死性炎症和纤维化消退的双重作用。
