Department of Nursing, Faculty of Nursing, Gifu Kyoritsu University.
Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Gifu.
Eur J Gastroenterol Hepatol. 2021 Dec 1;33(1S Suppl 1):e513-e521. doi: 10.1097/MEG.0000000000002139.
There is insufficient information to evaluate the correlation between fibrosis regression and hepatocellular carcinoma (HCC) risk after hepatitis C virus eradication. We analyzed serial changes in fibrosis (FIB)-4 scores after sustained virological response (SVR).
The subjects were 717 patients who achieved SVR by interferon (IFN)-based therapy (IFN Group) and 635 patients who achieved SVR by direct-acting antiviral (DAA) therapy (DAA Group). We performed propensity score matching because the baseline characteristics differed between the IFN and DAA groups, and then applied inverse probability weighting (IPW). We compared the changes in FIB-4 scores between the IFN and DAA groups. We also investigated the dynamics of FIB-4 scores, which are useful for predicting hepatocarcinogenesis.
Using time-dependent receiver operating characteristic curve analysis and an IPW-adjusted Cox proportional hazards model, we identified an FIB-4 cutoff of 1.50 for predicting hepatocarcinogenesis. The percentages of patients in the IFN and DAA groups who demonstrated IPW-adjusted cumulative reduction and increase in FIB-4 scores indicated no significant differences. No HCC developed during the 5-year follow-up period in 547 of the 1352 patients whose FIB-4 score was <1.50 at SVR or improved from ≥1.50 to <1.50 during follow-up. Only one patient developed HCC, at 7.3 years; this individual had diabetes mellitus and excessive alcohol intake.
There was no difference in FIB-4 score reduction between the IFN and DAA groups. Patients whose FIB-4 scores improved to <1.50 or remained at <1.50 during follow-up after SVR had extremely low hepatocarcinogenesis rates.
目前尚无足够信息评估丙型肝炎病毒（HCV）清除后纤维化消退与肝细胞癌（HCC）风险之间的相关性。我们分析了持续病毒学应答（SVR）后纤维化（FIB）-4 评分的连续变化。
本研究共纳入 717 例接受干扰素（IFN）为基础的治疗（IFN 组）和 635 例接受直接作用抗病毒（DAA）药物治疗（DAA 组）后获得 SVR 的患者。由于 IFN 组和 DAA 组的基线特征存在差异，我们采用倾向评分匹配，并应用逆概率加权（IPW）法。我们比较了 IFN 组和 DAA 组之间 FIB-4 评分的变化。此外，我们还研究了 FIB-4 评分的动态变化，这对于预测肝癌发生具有重要意义。
采用时间依赖性受试者工作特征曲线分析和 IPW 校正的 Cox 比例风险模型，我们确定了 1.50 作为预测 HCC 发生的 FIB-4 截断值。在 SVR 时 FIB-4 评分<1.50 或随访期间从≥1.50 降至<1.50 的 1352 例患者中，IPW 校正后 FIB-4 评分累积降低和增加的患者比例在 IFN 组和 DAA 组之间无显著差异。在 5 年随访期间，547 例 FIB-4 评分<1.50 或随访期间从≥1.50 降至<1.50 的患者中无 HCC 发生。仅有 1 例患者于第 7.3 年发生 HCC，该患者患有糖尿病和过量饮酒。
IFN 组和 DAA 组之间 FIB-4 评分降低无差异。SVR 后 FIB-4 评分改善至<1.50 或保持在<1.50 以下的患者 HCC 发生率极低。
