Rewisha Eman, Salman Tary, Alhaddad Omkolsoum, Raia Gamal Abo, Naguib Mary, Rashad Shymaa, Abdelfattah Ahmed, Metwally Khaled, Abdelsameea Eman
Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Egypt.
Clinical Pathology Department, National Liver Institute, Menoufia University, Egypt.
Clin Exp Hepatol. 2021 Sep;7(3):320-327. doi: 10.5114/ceh.2021.109293. Epub 2021 Sep 22.
Fibrosis is an inevitable complication of chronic hepatitis C virus (HCV) infection. Direct acting antivirals (DAAs) radically treated HCV and were suggested to ameliorate fibrosis. Silymarin (a natural herbal remedy) was proposed to further decrease hepatic inflammation and fibrosis. Consequently, serial monitoring of liver fibrosis status by different biomarkers is needed.
To assess hyaluronic acid (HA) as a potential marker of fibrosis regression after DAAs in chronic HCV patients; in addition, to evaluate silymarin as an agent that, beside DAAs, could further improve fibrosis.
Two groups were included (150 patients each). Group 1 received DAAs only, while group 2 received DAAs followed by silymarin. Hyaluronic acid and FIB4 score were assessed at baseline before treatment and 1 year after inclusion in the study.
We found that DAA therapy alone or in combination with silymarin resulted in a significant reduction in serum HA level. However, the latter case showed a statistically significantly greater reduction ( = 0.034). Mean ±SD of serum HA level was 211.8 ±179.9 and 143.3 ±123.9 µg/l before and one year after inclusion respectively in group 1 ( = 0.001) and also, its level decreased significantly in group 2 from 188.3 ±211.8 µg/l before receiving DAAs to 126.4 ±136.9 µg/l at one year after inclusion ( = 0.001). There was no significant difference between the 2 studied groups as regards FIB-4 at 1 year after inclusion ( = 0.103).
Hyaluronic acid might be a sensitive marker for monitoring fibrosis regression in treated chronic HCV patients. Adding silymarin to treatment protocols could ameliorate the fibrosis status.
纤维化是慢性丙型肝炎病毒（HCV）感染不可避免的并发症。直接抗病毒药物（DAAs）可根治HCV，并被认为可改善纤维化。水飞蓟素（一种天然草药疗法）被提议可进一步减轻肝脏炎症和纤维化。因此，需要通过不同生物标志物对肝纤维化状态进行连续监测。
评估透明质酸（HA）作为慢性HCV患者接受DAAs治疗后纤维化消退的潜在标志物；此外，评估水飞蓟素作为一种除DAAs外可进一步改善纤维化的药物。
纳入两组（每组150例患者）。第1组仅接受DAAs治疗，而第2组接受DAAs治疗后再接受水飞蓟素治疗。在治疗前基线时以及纳入研究1年后评估透明质酸和FIB4评分。
我们发现单独使用DAA疗法或联合水飞蓟素治疗均导致血清HA水平显著降低。然而，后一种情况显示出统计学上显著更大程度的降低（P = 0.034）。第1组纳入前和纳入1年后血清HA水平的平均值±标准差分别为211.8±179.9和143.3±123.9μg/l（P = 0.001），并且第2组其水平也从接受DAAs治疗前的188.3±211.8μg/l显著降至纳入1年后的126.4±136.9μg/l（P = 0.001）。纳入1年后，两组在FIB - 4方面无显著差异（P = 0.103）。
透明质酸可能是监测接受治疗的慢性HCV患者纤维化消退的敏感标志物。在治疗方案中添加水飞蓟素可改善纤维化状态。
