直接抗病毒治疗可提高丙型肝炎病毒相关冷球蛋白血症患者的肾脏存活率：RENALCRYOGLOBULINEMIC研究
Direct-acting antiviral therapy improves kidney survival in hepatitis C virus-associated cryoglobulinaemia: the RENALCRYOGLOBULINEMIC study.
作者信息
Pérez de José Ana, Carbayo Javier, Pocurull Anna, Bada-Bosch Teresa, Cases Corona Clara Maria, Shabaka Amir, Ramos Terrada Natàlia, Martinez Valenzuela Laura, Huerta Ana, Fernandez Lorente Loreto, Malek-Marín Tamara Gelen, Goicoechea Marian
机构信息
Department of Nephrology, University Hospital Gregorio Marañón, Madrid, Spain.
Department of Gastroenterology and Hepatology, Hospital Clínic de Barcelona, Barcelona, Spain.
出版信息
Clin Kidney J. 2020 Jan 25;14(2):586-592. doi: 10.1093/ckj/sfz178. eCollection 2021 Feb.
BACKGROUND
Direct-acting antiviral agents (DAAs) have shown high rates of sustained virological response in chronic hepatitis C virus (HCV) infection. However, the influence of DAAs on the course of kidney involvement in HCV-associated mixed cryoglobulinaemia (HCV-MC) has been little studied. The aim of this study was to analyse the effects of antiviral treatment on kidney prognosis and evolution in patients diagnosed with HCV-MC.
METHODS
The RENALCRYOGLOBULINEMIC study is an observational multicentre cohort study of 139 patients with HCV-MC from 14 Spanish centres. Clinical and laboratory parameters were measured before and after antiviral treatment. Primary endpoints were kidney survival and mortality after HCV-MC diagnosis. Secondary endpoints were clinical, immunological and virological responses after antiviral treatment.
RESULTS
Patients were divided into three groups based on the treatment received: treatment with DAAs ( = 100) treatment with interferon (IFN) and ribavirin (RBV) ( = 24) and no treatment ( = 15). Patients were followed up for a median duration of 138 months (interquartile range 70-251. DAA treatment reduced overall mortality {hazard ratio [HR] 0.12 [95% confidence interval (CI) 0.04-0.40]; P < 0.001} and improved kidney survival [HR 0.10 ( 95% CI 0.04-0.33); P < 0.001].
CONCLUSIONS
Results from the RENALCRYOGLOBULINEMIC study indicated that DAA treatment in patients with HCV-MC improves kidney survival and reduces mortality.
背景
直接抗病毒药物（DAAs）在慢性丙型肝炎病毒（HCV）感染中显示出较高的持续病毒学应答率。然而，DAAs对HCV相关混合性冷球蛋白血症（HCV-MC）患者肾脏受累病程的影响鲜有研究。本研究旨在分析抗病毒治疗对诊断为HCV-MC患者肾脏预后及病情演变的影响。
方法
RENALCRYOGLOBULINEMIC研究是一项观察性多中心队列研究，纳入了来自14个西班牙中心的139例HCV-MC患者。在抗病毒治疗前后测量临床和实验室参数。主要终点为HCV-MC诊断后的肾脏生存率和死亡率。次要终点为抗病毒治疗后的临床、免疫和病毒学应答。
结果
根据接受的治疗将患者分为三组：接受DAAs治疗（n = 100）、接受干扰素（IFN）和利巴韦林（RBV）治疗（n = 24）以及未接受治疗（n = 15）。患者的中位随访时间为138个月（四分位间距70 - 251）。DAAs治疗降低了总体死亡率{风险比[HR] 0.12 [95%置信区间（CI）0.04 - 0.40]；P < 0.001}，并改善了肾脏生存率[HR 0.10（95% CI 0.04 - 0.33）；P < 0.001]。
结论
RENALCRYOGLOBULINEMIC研究结果表明，HCV-MC患者接受DAAs治疗可改善肾脏生存率并降低死亡率。
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