Sangineto Moris, Luglio Chiara Valentina, Mastrofilippo Tommaso, Zingaro Maria Teresa, Berardi Elsa, Antonica Gianfranco, Sabbà Carlo, Napoli Nicola
Department of Interdisciplinary Medicine, University of Bari, Bari, Italy.
Department of Interdisciplinary Medicine, University of Bari, Bari, Italy; Present address: Department of Internal Medicine, Hospital San Pio da Pietrelcina, Castellaneta (Taranto), Italy.
Med Clin (Barc). 2021 Apr 9;156(7):317-323. doi: 10.1016/j.medcli.2020.04.050. Epub 2020 Aug 9.
Despite chronic hepatitis C (CHC) is still a global burden as the high morbidity and mortality, the recently approved direct-acting antivirals (DAAs) permit a very high rate of sustained virologic response (SVR) in these patients. The clinical improvement due to viral eradication is being documented, however it is not clear why a subset of patients does not benefit in terms of fibrosis regression or hepatocellular carcinoma (HCC) development. Aim of the study was to assess the hepatic stiffness regression at SVR24 and detect factors impacting stiffness course.
Hepatic stiffness assessed by acoustic radiation force impulse (ARFI) and anthropometric- and biochemical parameters were retrospectively collected by 166 CHC patients treated with DAAs, form baseline and SVR24.
Viral eradication significantly improved overall hepatic stiffness and other related hepatitis hallmarks such as ALT, AST, γGT, platelets count, AST to Platelets ratio Index (APRI), total- and LDL cholesterol. The multiple regression analysis showed that patients with baseline glucose > 110mg/dl presented a stiffness regression significantly lower when compared to low glucose patients (<110mg/dl), moreover baseline HbA1c strongly correlated with DeltaStiffness. 7 patients (4.2%) developed HCC and importantly, presented hyperglycaemia and no stiffness regression nor platelets count recover.
Although viral eradication with DAAs entails overall benefits, glycaemic decompensation negatively affects fibrosis regression and probably facilitates HCC development.
尽管慢性丙型肝炎（CHC）因其高发病率和死亡率仍是一项全球负担，但近期获批的直接抗病毒药物（DAAs）使这些患者实现持续病毒学应答（SVR）的比例非常高。病毒清除带来的临床改善已有记录，但尚不清楚为何部分患者在纤维化消退或肝细胞癌（HCC）发生方面未获益处。本研究的目的是评估SVR24时的肝硬度消退情况，并检测影响肝硬度变化过程的因素。
回顾性收集了166例接受DAAs治疗的CHC患者在基线和SVR24时通过声辐射力脉冲（ARFI）评估的肝硬度以及人体测量和生化参数。
病毒清除显著改善了整体肝硬度以及其他相关肝炎指标，如谷丙转氨酶（ALT）、谷草转氨酶（AST）、γ-谷氨酰转肽酶（γGT）、血小板计数、AST与血小板比值指数（APRI）、总胆固醇和低密度脂蛋白胆固醇。多元回归分析显示，基线血糖>110mg/dl的患者与低血糖患者（<110mg/dl）相比，肝硬度消退明显更低，此外基线糖化血红蛋白（HbA1c）与肝硬度变化量（DeltaStiffness）密切相关。7例患者（4.2%）发生了HCC，重要的是，这些患者出现高血糖，且肝硬度无消退，血小板计数也未恢复。
尽管使用DAAs清除病毒带来了总体益处，但血糖失代偿对纤维化消退产生负面影响，可能还会促进HCC的发生。
