Hanafy Amr Shaaban, Basha Mohamed Abdel Khalik, Wadea Fady Maher
Department of Internal Medicine, Gastroenterology and Hepatology Division, Zagazig University Hospital, Zagazig 44519, Egypt.
Department of Diagnostic Radiology, Zagazig University, Zagazig 44519, Egypt.
World J Hepatol. 2020 Oct 27;12(10):850-862. doi: 10.4254/wjh.v12.i10.850.
Hepatitis C virus (HCV) infection may affect lipid metabolism by enhancing the circulating levels of inflammatory cytokines, together with its impact on endothelial function.
To evaluate the potential correlation of changes in lipid profile, carotid intima-media thickness (CIMT), and ankle-brachial index with the severity of fibrosis, grades of esophageal varices (EVs), and fibrosis indices.
The study included 240 subjects who were divided into 3 groups; group 1 ( = 90, HCV-related cirrhotic patients with EVs), group 2 ( = 90, HCV-related cirrhotic patients without EVs), and group 3 ( = 60, served as the healthy control group). All patients underwent routine laboratory tests, including a lipid profile assay. Low-density lipoproteins (LDL)/platelet count and platelet/splenic diameter ratios were calculated. Abdominal ultrasonography, CIMT by carotid Doppler, bedside ankle-brachial index (ABI), liver stiffness measurement, and upper gastrointestinal endoscopy were performed.
Multivariate logistic regression revealed that very-low-density lipoprotein (VLDL) (β = 0.988, odds ratio 2.5, = 0.001), LDL/platelet count ratio (β = 1.178, odds ratio 3.24, = 0.001), CIMT (β = 1.37, odds ratio 3.9, = 0.001), and ABI (β = 2.3, odds ratio 5.9, = 0.001) were the key variables associated with significant fibrosis, EVs and endothelial dysfunction. CIMT and LDL/platelet count ratio were predictive of advanced fibrosis and EVs at cutoff values of 1.1 mm and 1 mm, respectively, with an area under the curve (AUC) of 0.966 and 0.960 ( = 0.001), while VLDL and ABI at a cutoff of 16.5 mg/dL and 0.94 were predictive of advanced fibrosis and EVs with an AUC of 0.891 and 0.823, respectively ( = 0.001).
CIMT, ABI, VLDL, LDL/platelet count ratio are good non-invasive predictors of advanced fibrosis, presence of EVs, and endothelial dysfunction in liver cirrhosis.
丙型肝炎病毒（HCV）感染可能通过提高炎症细胞因子的循环水平影响脂质代谢，并对内皮功能产生影响。
评估脂质谱变化、颈动脉内膜中层厚度（CIMT）和踝臂指数与纤维化严重程度、食管静脉曲张（EVs）分级及纤维化指标之间的潜在相关性。
该研究纳入240名受试者，分为3组；第1组（n = 90，患有EVs的HCV相关性肝硬化患者），第2组（n = 90，无EVs的HCV相关性肝硬化患者），第3组（n = 60，作为健康对照组）。所有患者均接受常规实验室检查，包括脂质谱分析。计算低密度脂蛋白（LDL）/血小板计数及血小板/脾脏直径比值。进行腹部超声检查、通过颈动脉多普勒测量CIMT、床边踝臂指数（ABI）、肝脏硬度测量及上消化道内镜检查。
多因素逻辑回归显示，极低密度脂蛋白（VLDL）（β = 0.988，比值比2.5，P = 0.001）、LDL/血小板计数比值（β = 1.178，比值比3.24，P = 0.001）、CIMT（β = 1.37，比值比3.9，P = 0.001）及ABI（β = 2.3，比值比5.9，P = 0.001）是与显著纤维化、EVs及内皮功能障碍相关的关键变量。CIMT和LDL/血小板计数比值分别在截断值为1.1 mm和1 mm时可预测晚期纤维化和EVs，曲线下面积（AUC）分别为0.966和0.960（P = 0.001），而VLDL和ABI在截断值为16.5 mg/dL和0.94时预测晚期纤维化和EVs的AUC分别为0.891和0.823（P = 0.001）。
CIMT、ABI、VLDL、LDL/血小板计数比值是肝硬化患者晚期纤维化、EVs存在及内皮功能障碍的良好非侵入性预测指标。
