非酒精性脂肪性肝病危险因素对丙型肝炎直接抗病毒治疗后肝脏相关结局的影响。
Nonalcoholic Fatty Liver Disease Risk Factors Affect Liver-Related Outcomes After Direct-Acting Antiviral Treatment for Hepatitis C.
机构信息
Pfleger Liver Institute, University of California Los Angeles, 200 Medical Plaza, Los Angeles, CA, 90095, USA.
Division of Gastroenterology, Hepatology and Parenteral Nutrition, Department of Medicine, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., Los Angeles, CA, 90073, USA.
出版信息
Dig Dis Sci. 2021 Jul;66(7):2394-2406. doi: 10.1007/s10620-020-06457-2. Epub 2020 Jul 11.
INTRODUCTION
In hepatitis C (HCV) patients, obesity and/or diabetes may increase the risk of liver-related outcomes. We aimed to determine whether diabetes and/or obesity are associated with adverse outcomes in direct-acting antiviral (DAA)-treated HCV patients.
METHODS
We conducted a retrospective study of 33,003 HCV-infected, DAA-treated Veterans between 2013 and 2015. Body mass index was used to categorize patients into underweight (< 18.5 kg/m), normal weight (18.5 to < 25 kg/m), overweight (25 to < 30 kg/m), obesity I (30 to < 35 kg/m), and obesity II-III (> 35 kg/m). Diabetes was defined by ICD-9/10 codes in association with hemoglobin A1c > 6.5% or medication prescriptions. Patients were followed from 180 days post-DAA initiation until 2/14/2019 to assess for development of cirrhosis, decompensations, hepatocellular carcinoma (HCC), and death. Multivariable Cox proportional hazards regression models were used to determine the association between diabetes and/or obesity and outcomes.
RESULTS
During a mean follow-up of 3 years, 10.1% patients died, 5.0% were newly diagnosed with cirrhosis, 4.7% had a decompensation and 4.0% developed HCC. Diabetes was associated with an increased risk of mortality (AHR = 1.25, 95% CI 1.10-1.42), cirrhosis (AHR = 1.31, 95% CI 1.16-1.48), decompensation (AHR = 1.74, 95% CI 1.31-2.31), and HCC (AHR = 1.32, 95% CI 1.01-1.72) among patients without baseline cirrhosis. Compared to normal-weight persons, obese persons had a higher risk of cirrhosis, but overweight and obese persons had lower risk of mortality and HCC.
CONCLUSIONS
In this large DAA-treated Veterans cohort, pre-DAA diabetes increases mortality and liver-related events independent of SVR. Continued vigilance is warranted in patients with diabetes despite SVR. Elevated BMI categories appear to have improved outcomes, although further studies are needed to understand those associations.
简介
在丙型肝炎（HCV）患者中，肥胖和/或糖尿病可能会增加肝脏相关结局的风险。我们旨在确定糖尿病和/或肥胖是否与接受直接作用抗病毒（DAA）治疗的 HCV 患者的不良结局相关。
方法
我们对 2013 年至 2015 年间 33003 名接受 HCV 感染和 DAA 治疗的退伍军人进行了一项回顾性研究。体重指数（BMI）用于将患者分为体重不足（<18.5kg/m）、正常体重（18.5-<25kg/m）、超重（25-<30kg/m）、肥胖 I（30-<35kg/m）和肥胖 II-III（>35kg/m）。糖尿病通过 ICD-9/10 代码与血红蛋白 A1c>6.5%或药物处方相关定义。从 DAA 开始后 180 天开始，患者接受随访至 2019 年 2 月 14 日，以评估肝硬化、失代偿、肝细胞癌（HCC）和死亡的发生情况。多变量 Cox 比例风险回归模型用于确定糖尿病和/或肥胖与结局之间的关联。
结果
在平均 3 年的随访期间，10.1%的患者死亡，5.0%新诊断为肝硬化，4.7%出现失代偿，4.0%发生 HCC。糖尿病与死亡率（AHR=1.25，95%CI 1.10-1.42）、肝硬化（AHR=1.31，95%CI 1.16-1.48）、失代偿（AHR=1.74，95%CI 1.31-2.31）和 HCC（AHR=1.32，95%CI 1.01-1.72）风险增加相关，在没有基线肝硬化的患者中。与正常体重的人相比，肥胖的人患肝硬化的风险更高，但超重和肥胖的人患死亡率和 HCC 的风险较低。
结论
在这项大型接受 DAA 治疗的退伍军人队列研究中，DAA 治疗前的糖尿病增加了死亡率和肝脏相关事件的风险，与 SVR 无关。尽管 SVR，但仍需要对糖尿病患者保持警惕。尽管需要进一步研究来了解这些关联，但升高的 BMI 类别似乎有改善的结局。
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