Department of Hepatology, Sapporo-Kosei General Hospital, Sapporo, Japan.
Department of Gastroenterology, Keiyukai Sapporo Hospital, Sapporo, Japan.
J Gastroenterol Hepatol. 2021 Feb;36(2):367-375. doi: 10.1111/jgh.15280. Epub 2020 Oct 11.
Since the advent of direct-acting antiviral (DAA) therapy, the total eradication of hepatitis C virus has been achievable with the recovery of hepatic reserve after achievement of sustained virologic response (SVR). Hence, here, we examined the factors affecting the recovery of hepatic reserve.
We followed up 403 patients (male: 164, female: 239; genotype 1: 299, genotype 2: 104; median age: 69 years) for at least 3 years after they achieved SVR to DAA therapy. Of these patients, 75 (18.6%) had a history of hepatocellular carcinoma (HCC). Biochemical tests were periodically performed, and the hepatic reserve was evaluated based on the albumin-bilirubin grade. We examined background factors such as age, biochemical test results, HCC occurrence and portosystemic shunt by computed tomography.
At the start of treatment, the albumin-bilirubin grades were grades 1, 2, and 3 in 241, 157, and 5 patients, respectively, and 3 years later, 117 of 162 (72%) patients with grade 2 or 3 improved to grade 1. Multivariate analysis identified the HCC occurrence after achievement of SVR (hazard ratio [HR]: 3.08, P < 0.0138), male sex (HR: 3.45, P = 0.0143), hemoglobin level of <11.5 g/dL (HR: 4.19, P = 0.0157), the presence of a portosystemic shunt (HR: 3.07, P = 0.0349), and alanine aminotransferase levels <45 U/L (HR: 2.67, P = 0.0425) as factors inhibiting improvement to grade 1. However, old age was not an inhibitory factor.
Our results demonstrate that hepatic reserve could be improved even in elderly patients over a long course of time.
自直接作用抗病毒（DAA）治疗问世以来，通过实现持续病毒学应答（SVR）后肝储备的恢复，已能实现丙型肝炎病毒的完全清除。因此，在这里，我们研究了影响肝储备恢复的因素。
我们对至少在 DAA 治疗后 3 年内达到 SVR 的 403 例患者（男性 164 例，女性 239 例；基因型 1：299 例，基因型 2：104 例；中位年龄 69 岁）进行了随访。这些患者中 75 例（18.6%）有肝细胞癌（HCC）病史。定期进行生化检查，并根据白蛋白-胆红素分级评估肝储备。我们通过计算机断层扫描检查了年龄等背景因素、生化检查结果、HCC 发生和门体分流。
治疗开始时，241 例患者的白蛋白-胆红素分级为 1 级，157 例患者为 2 级，5 例患者为 3 级，3 年后，162 例中 117 例（72%）的 2 级或 3 级患者改善为 1 级。多变量分析确定了 SVR 后 HCC 发生（风险比[HR]：3.08，P < 0.0138）、男性（HR：3.45，P = 0.0143）、血红蛋白水平 < 11.5 g/dL（HR：4.19，P = 0.0157）、门体分流存在（HR：3.07，P = 0.0349）和丙氨酸氨基转移酶水平 < 45 U/L（HR：2.67，P = 0.0425）是抑制改善至 1 级的因素。然而，年龄较大并不是一个抑制因素。
我们的结果表明，即使在老年患者中，肝储备也可以在很长一段时间内得到改善。
