Estefan Sergio, Brandão-Melo Carlos Eduardo, Dos Santos Silva Cintia Marques, Gomes Danilo Cosme Klein, Cardoso Paula, Costa Marcia Helena S
Endocrinology and Hepatology Division of Federal University of Rio de Janeiro State, Rio de Janeiro, Brazil.
Front Med (Lausanne). 2021 May 31;8:631600. doi: 10.3389/fmed.2021.631600. eCollection 2021.
Epidemiological data clearly indicate a link between hepatitis C virus (HCV) and altered glucose homeostasis. To evaluate the response of treatment with direct antiviral agents (DAAs) on metabolic variables of patients with hepatitis C. Observational, cross-sectional study in a sample of patients with hepatitis C starting therapy with DAAs followed on the hepatology division of Federal University of Rio de Janeiro State. Data were collected in two stages: before the start of therapy and between 12 and 52 weeks after obtaining the sustained virological response. In the baseline assessment of the 97 patients selected, 19.3% were obese, 38.6% were overweight, 50% were hypertensive, 43.8% were pre-diabetic, 12.5% were diabetic, 31.2% were dyslipidemic, and 21.8% had metabolic syndrome. There was an increase in total cholesterol and LDL levels ( < 0.001), and a non-significant reduction in blood glucose, glycated hemoglobin, insulin, and HOMA-IR levels after treatment. In the post-treatment, there was a reduction in fibrosis ( = 0.016), with a reduction in the levels of GGT, AST, and ALT (all with < 0.001), as well as in the FIB4 and APRI scores (both with < 0.001) and in the degree of fibrosis evaluated by elastography represented in kPa ( = 0.006). The blood glucose level was higher in patients with steatosis ( = 0.039) after treatment. There was a positive pre-treatment correlation between the degree of fibrosis (kPa) and FIB4 ( = 0.319, = 0.004), APRI ( = 0.287, = 0.010), and the NAFLD score ( = 0.275, = 0.016). Patients with hepatitis C had a high prevalence of metabolic disturbance in the pre-treatment phase, but the therapy did not show beneficial effects, especially on glucose metabolism.
流行病学数据清楚地表明丙型肝炎病毒（HCV）与葡萄糖稳态改变之间存在关联。为评估直接抗病毒药物（DAA）治疗对丙型肝炎患者代谢变量的反应。在里约热内卢州联邦大学肝病科对开始接受DAA治疗的丙型肝炎患者样本进行观察性横断面研究。数据分两个阶段收集：治疗开始前以及获得持续病毒学应答后的12至52周之间。在入选的97例患者的基线评估中，19.3%为肥胖，38.6%为超重，50%为高血压，43.8%为糖尿病前期，12.5%为糖尿病，31.2%为血脂异常，21.8%患有代谢综合征。治疗后总胆固醇和低密度脂蛋白水平升高（P<0.001），血糖、糖化血红蛋白、胰岛素和HOMA-IR水平有非显著性降低。治疗后，纤维化程度降低（P = 0.016），γ-谷氨酰转移酶、天冬氨酸转氨酶和丙氨酸转氨酶水平降低（均P<0.001），FIB4和APRI评分降低（均P<0.001），通过弹性成像评估的以kPa表示的纤维化程度降低（P = 0.006）。治疗后脂肪变性患者的血糖水平较高（P = 0.039）。治疗前纤维化程度（kPa）与FIB4（r = 0.319，P = 0.004）、APRI（r = 0.287，P = 0.010）和非酒精性脂肪性肝病评分（r = 0.275，P = 0.016）之间存在正相关。丙型肝炎患者在治疗前期代谢紊乱的患病率较高，但该治疗未显示出有益效果，尤其是对葡萄糖代谢。
