Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Division of Gastroenterology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
J Viral Hepat. 2021 Jan;28(1):159-167. doi: 10.1111/jvh.13406. Epub 2020 Sep 24.
Chronic hepatitis C virus (HCV) infection is associated with risk of cardiovascular diseases. Although direct-acting antivirals (DAA) result in rapid eradication of HCV, their long-term impact on arterial stiffness remains unclear. This study aimed to evaluate changes in parameters of central arterial stiffness from pretreatment, through sustained virological response, to one year after viral clearance. Patients with chronic HCV receiving DAA treatment were enrolled prospectively. Medical history and comorbidities of all patients were collected. Lipid profiles, liver stiffness by transient elastography and central blood pressures using pulse wave analysis of the brachial artery by cuff sphygmomanometry were measured before treatment, at viral clearance and at one year following viral clearance. Augmentation index (AIx), a parameter of aortic stiffness, was calculated as the ratio of augmentation pressure to central pulse pressure. After DAA treatment, all included patients with chronic HCV (n = 102) had achieved viral clearance. Cholesterol, low-density lipoprotein (LDL) and triglyceride/high-density lipoprotein (TG/HDL) increased significantly at viral clearance and persisted at one year (all P < .001). AIx was also elevated significantly at viral clearance and persisted one year later (P < .001). Changes in AIx remained significant only in patients with increased values from baseline in either LDL (P < .01) or TG/HDL (P < .001). Central arterial stiffness and lipid profiles in patients with chronic HCV worsen immediately after viral eradication by DAA treatment and persist at one year. Worsening of lipid profiles after DAA treatment contributes to central arterial stiffness in this patient population and persists long term.
慢性丙型肝炎病毒（HCV）感染与心血管疾病风险相关。尽管直接作用抗病毒药物（DAA）可迅速清除 HCV，但它们对动脉僵硬度的长期影响尚不清楚。本研究旨在评估从治疗前、持续病毒学应答到病毒清除后 1 年期间，中央动脉僵硬度参数的变化。前瞻性招募接受 DAA 治疗的慢性 HCV 患者。收集所有患者的病史和合并症。在治疗前、病毒清除时和病毒清除后 1 年，使用肱动脉袖带血压计通过脉搏波分析测量血脂谱、瞬时弹性成像测定的肝硬度和中心血压。通过将增强压与中心脉搏压的比值计算出主动脉僵硬度的参数，即增强指数（AIx）。在 DAA 治疗后，所有纳入的慢性 HCV 患者（n=102）均实现了病毒清除。胆固醇、低密度脂蛋白（LDL）和甘油三酯/高密度脂蛋白（TG/HDL）在病毒清除时显著升高，并持续到 1 年（均 P<.001）。AIx 在病毒清除时也显著升高，并在 1 年后持续升高（P<.001）。仅在 LDL（P<.01）或 TG/HDL（P<.001）基线值升高的患者中，AIx 的变化仍具有统计学意义。慢性 HCV 患者的中央动脉僵硬度和血脂谱在 DAA 治疗清除病毒后立即恶化，并持续 1 年。DAA 治疗后血脂谱恶化导致该患者人群的中央动脉僵硬度恶化，并持续长期存在。
