Servicio de Aparato Digestivo, Hospital Universitario de Burgos, Burgos, España.
Servicio de Aparato Digestivo, Hospital Universitario de Burgos, Burgos, España.
Gastroenterol Hepatol. 2022 Dec;45(10):767-779. doi: 10.1016/j.gastrohep.2022.02.002. Epub 2022 Feb 18.
To analyze laboratory parameters, clinical and fibrosis evolution in F3-F4 patients cured with direct-acting antivirals (DAA).
Unicenteric, observational and prospective study. All F3-F4 hepatitis C patients cured with DAA from 01/11/2014 to 31/08/2019 were included. A basal visit (BV) was performed and at 12 weeks (12w), 1, 2, 3 and 4 years after treatment. Demographic and laboratory variables, fibrosis measured by non-invasive tests, indirect markers of portal hypertension, the presence of esophageal varices, cirrhosis decompensation and hepatoceullar carcinoma were collected.
169 patients were treated: 123 (72.8%) men, age 57.5±12 years; 117 (69.2%) with cirrhosis, 99 (84.6%) ChildA. 96,4% achieved SVR. The study was conducted for a median follow-up of 46.14 (2.89-62.55) months. It was observed a significant increase in platelets [155×10/μL (BV); 163×10/μL (12w)], cholesterol [158mg/dL (BV); 179mg/dL (12w)] and albumin [4.16g/dL (BV); 4.34g/dL (12w)] and a significant decrease in ALT [82UI/L (BV); 23UI/L (12w], AST [69UI/L (BV); 26UI/L (12w)], GGT [118UI/L (BV); 48UI/L (12w)] and bilirrubin [0.9mg/dL (BV); 0.7mg/dL (12w)]. Fibrosis also improved early in follow-up, both by serological methods and Fibroscan [19.9kPa (BV); 14.8kPa (12w; P<.05]. 8.1% of compensated cirrhosis patients had some decompensation. 4.5% developed esophageal varices. Nine patients (5.52%) had de novo hepatocellular carcinoma; 6 (3.68%) had hepatoceullar carcinoma in BV and 40% had a recurrence. During follow-up mortality was 9.2%.
There is an improvement in laboratory parameters and fibrosis measured by non-invasive methods in F3-F4 patients cured with DAA. However, the risk of decompensation and the incidence/recurrence of hepatocellular carcinoma still remain, so there is a need to follow these patients.
分析 F3-F4 期丙型肝炎患者经直接作用抗病毒药物（DAA）治愈后的实验室参数、临床和纤维化演变情况。
单中心、观察性和前瞻性研究。纳入 2014 年 11 月 1 日至 2019 年 8 月 31 日期间使用 DAA 治愈的所有 F3-F4 期丙型肝炎患者。进行基线访视（BV），并在治疗后 12 周（12w）、1、2、3 和 4 年进行随访。收集人口统计学和实验室变量、通过非侵入性试验测量的纤维化、间接门静脉高压标志物、食管静脉曲张的存在、肝硬化失代偿和肝细胞癌。
169 例患者接受治疗：123 例（72.8%）为男性，年龄 57.5±12 岁；117 例（69.2%）患有肝硬化，99 例（84.6%）为 ChildA 级。96.4%的患者达到了 SVR。研究中位随访时间为 46.14 个月（2.89-62.55）。观察到血小板[155×10/μL（BV）；163×10/μL（12w）]、胆固醇[158mg/dL（BV）；179mg/dL（12w）]和白蛋白[4.16g/dL（BV）；4.34g/dL（12w）]显著增加，而丙氨酸氨基转移酶[82UI/L（BV）；23UI/L（12w）]、天冬氨酸氨基转移酶[69UI/L（BV）；26UI/L（12w）]、γ-谷氨酰转移酶[118UI/L（BV）；48UI/L（12w）]和胆红素[0.9mg/dL（BV）；0.7mg/dL（12w）]显著降低。纤维化也在随访早期得到改善，无论是通过血清学方法还是 Fibroscan[19.9kPa（BV）；14.8kPa（12w）；P<.05]。8.1%的代偿性肝硬化患者出现了一定程度的失代偿。4.5%的患者出现食管静脉曲张。9 例（5.52%）患者新发肝细胞癌；6 例（3.68%）患者在 BV 时出现肝细胞癌，40%的患者出现复发。随访期间死亡率为 9.2%。
F3-F4 期丙型肝炎患者经 DAA 治愈后，实验室参数和非侵入性方法测量的纤维化均有所改善。然而，失代偿的风险和肝细胞癌的发生/复发仍然存在，因此需要对这些患者进行随访。
