Liver Section, Gastroenterology Department, Hospital del Mar, Barcelona, Spain.
Universitat Autònoma de Barcelona (UAB), Departament de Medicina de la UAB, Barcelona, Spain.
Liver Int. 2021 Nov;41(11):2733-2746. doi: 10.1111/liv.15058. Epub 2021 Sep 21.
Liver fibrosis and transient elastography (TE) correlation in hepatitis C virus (HCV)-infected patients with compensated advanced chronic liver disease (cACLD) after the sustained virological response (SVR) is unknown.
To evaluate TE accuracy at identifying cirrhosis 3 years after HCV-eradication.
Prospective, multi-centric study including HCV-cACLD patients before direct-acting antivirals (DAA). Diagnostic accuracy of TE (area under ROC, AUROC) to identify cirrhosis 3 years after SVR was evaluated.
Among 746 HCV-infected patients (95.4% with TE ≥10 kPa), 76 (10.2%) underwent a liver biopsy 3 years after SVR. Before treatment, 46 (63%) showed a TE>15 kPa. The TE before DAA was the best variable for predicting cirrhosis (METAVIR, F4) after SVR (AUROC = 0.79). Liver function parameters, serological non-invasive tests (APRI and FIB-4), and TE values improved after SVR. However, liver biopsy 3 years after HCV elimination (median time = 38.4 months) showed cirrhosis in 41 (53.9%). Multivariate analysis (OR (95% CI), P) showed that HCV-genotype 3 (20.81 (2.12-201.47), .009), and TE before treatment (1.21 (1.09-1.34), <.001) were the only variables associated with cirrhosis after SVR. However, the accuracy of TE after SVR was poor (AUROC = 0.75) and 6 (27.3%) out of 22 patients with a TE <8 kPa had cirrhosis. Similar results were found with APRI and FIB-4 scores.
Cirrhosis is present, 3 years after SVR, in more than half of HCV-cACLD patients even with the normalisation of liver function parameters, serological non-invasive tests and TE values. The low diagnostic accuracy of non-invasive methods after SVR reinforces the need for long-term surveillance.
慢性丙型肝炎病毒（HCV）感染患者在获得持续病毒学应答（SVR）后，代偿性晚期慢性肝病（cACLD）患者的肝纤维化与瞬时弹性成像（TE）的相关性尚不清楚。
评估 HCV 清除后 3 年内 TE 识别肝硬化的准确性。
前瞻性、多中心研究包括直接作用抗病毒药物（DAA）前的 HCV-cACLD 患者。评估 TE（ROC 曲线下面积，AUROC）在 HCV 清除后 3 年内识别肝硬化的诊断准确性。
在 746 例 HCV 感染患者中（95.4%的患者 TE≥10kPa），76 例（10.2%）在 SVR 后 3 年内进行了肝活检。治疗前，46 例（63%）的 TE>15kPa。TE 是 SVR 后预测肝硬化（METAVIR，F4）的最佳变量（AUROC=0.79）。SVR 后肝功能参数、血清学无创检测（APRI 和 FIB-4）和 TE 值均有所改善。然而，HCV 清除后 3 年（中位时间=38.4 个月）的肝活检显示 41 例（53.9%）存在肝硬化。多变量分析（OR（95%CI），P）显示，HCV 基因型 3（20.81（2.12-201.47），.009）和治疗前的 TE（1.21（1.09-1.34），<.001）是 SVR 后肝硬化的唯一相关变量。然而，SVR 后 TE 的准确性较差（AUROC=0.75），22 例 TE<8kPa 的患者中有 6 例（27.3%）存在肝硬化。APRI 和 FIB-4 评分也有类似结果。
即使肝功能参数、血清学无创检测和 TE 值均正常，HCV-cACLD 患者在 SVR 后 3 年内仍有超过一半存在肝硬化。SVR 后非侵入性方法的低诊断准确性强调了长期监测的必要性。
