通过剪切波弹性成像评估的肝硬度在慢性 HCV 感染患者接受 DAA 治疗期间与免疫调节蛋白平行下降。

Liver stiffness assessed by shear-wave elastography declines in parallel with immunoregulatory proteins in patients with chronic HCV infection during DAA therapy.

机构信息

Department of Gastroenterology, Endocrinology, Rheumatology and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany.

Department of Radiology University Hospital Regensburg, Regensburg, Germany.

出版信息

Clin Hemorheol Microcirc. 2021;79(4):541-555. doi: 10.3233/CH-211193.

DOI:10.3233/CH-211193

PMID:34120896

Abstract

BACKGROUND

A rapid decline of liver stiffness (LS) was detected by non-invasive methods in patients with chronic hepatitis C (HCV) infection during treatment with direct-acting antivirals (DAA).

OBJECTIVE

To investigate the influence of inflammation on LS.

METHODS

We prospectively examined LS by sonographic shear-wave elastography in 217 patients during DAA therapy from treatment initiation (BL) to 12 weeks after end of therapy (SVR12). Demographic data, laboratory findings and serum levels of cytokines were determined.

RESULTS

Values of LS decreased from 1.86 m/s to 1.68 m/s (p = 0.01) which was most pronounced in patients who had F4 fibrosis at BL (3.27 m/s to 2.37 m/s; p < 0.001). Initially elevated values of aminotransferases, ferritin, IgG (p < 0.001 each) and international normalized ratio (p < 0.003) declined, thrombocyte count (p = 0.007) increased. Correlations of these laboratory parameters with BL levels of LS measurement (LSM) were most apparent in patients with F1-F3 fibrosis. Tumor necrosis factor (TNF)-α (p = 0.031), interleukin (IL)-10 (p = 0.005) and interferon y inducible protein (IP)-10 (p < 0.001) decreased in parallel with LSM under DAA therapy and corelated with BL values.

CONCLUSION

Decrease of systemic inflammatory parameters correlated with LSM under DAA therapy. We conclude that regression of LSM is attributable to the decline of inflammation rather than reflecting fibrosis.

摘要

背景

在慢性丙型肝炎（HCV）感染患者接受直接作用抗病毒药物（DAA）治疗期间，非侵入性方法检测到肝硬度（LS）迅速下降。

目的

研究炎症对 LS 的影响。

方法

我们前瞻性地通过超声剪切波弹性成像在 217 例 DAA 治疗期间的患者中检测 LS，从治疗开始（BL）到治疗结束后 12 周（SVR12）。测定人口统计学资料、实验室检查结果和细胞因子血清水平。

结果

LS 值从 1.86 m/s 降至 1.68 m/s（p = 0.01），在 BL 时纤维化程度为 F4 的患者降幅最大（3.27 m/s 至 2.37 m/s；p < 0.001）。最初升高的转氨酶、铁蛋白、IgG（p < 0.001 各）和国际标准化比值（p < 0.003）下降，血小板计数（p = 0.007）增加。这些实验室参数与 BL 时 LS 测量值（LSM）的相关性在纤维化程度为 F1-F3 的患者中最为明显。肿瘤坏死因子（TNF）-α（p = 0.031）、白细胞介素（IL）-10（p = 0.005）和干扰素诱导蛋白（IP）-10（p < 0.001）在 DAA 治疗期间与 LSM 平行下降，与 BL 值相关。