Division of General Medicine C, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
Liver Unit, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
J Dig Dis. 2022 May;23(5-6):324-330. doi: 10.1111/1751-2980.13103. Epub 2022 Jul 11.
Hepatitis C virus (HCV) infection is associated with an increased risk of type 2 diabetes mellitus (T2DM) and cardiovascular diseases. The impact of HCV eradication on the metabolic profile in diabetic patients treated with direct-acting antiviral agents (DAAs) is not well defined. The aim of our study was to evaluate the effects of DAAs on a lipid and glucose profile in a cohort of diabetic patients with different liver fibrotic stages.
T2DM patients with active HCV infection were consecutively enrolled in this prospective trial. Glycolipidic status was assessed, before starting DAA treatment (T0) and at 12 months after the beginning of treatment (T1). Liver fibrotic stage was assessed by FibroScan.
In all, 131 patients were enrolled and all of them achieved a sustained virologic response. At baseline, no significant differences were found in lipid and glucose profiles in subgroup analysis by liver fibrosis, HCV genotype, and cardiovascular risk factors. At T1, total cholesterol and low-density lipoprotein cholesterol, but not triglycerides, significantly increased irrespective of liver fibrotic stage and baseline anthropometric and clinical profiles, while glycated hemoglobin significantly decreased only in F4 patients.
HCV eradication in diabetic patients is associated with a worsening lipid profile that could impact future cardiovascular risk. A careful global monitoring of cardiovascular risk factors in all diabetic patients after HCV eradication is needed.
丙型肝炎病毒（HCV）感染与 2 型糖尿病（T2DM）和心血管疾病的风险增加有关。直接作用抗病毒药物（DAA）治疗的糖尿病患者中 HCV 清除对代谢特征的影响尚未明确。我们的研究目的是评估 DAA 对不同肝纤维化阶段的糖尿病患者脂质和葡萄糖谱的影响。
本前瞻性试验连续纳入了患有活动性 HCV 感染的 T2DM 患者。在开始 DAA 治疗前（T0）和治疗开始后 12 个月（T1）评估糖脂状态。通过 FibroScan 评估肝纤维化分期。
共纳入 131 例患者，所有患者均达到持续病毒学应答。在肝纤维化、HCV 基因型和心血管危险因素的亚组分析中，基线时脂质和葡萄糖谱无显著差异。在 T1 时，总胆固醇和低密度脂蛋白胆固醇显著增加，而不管肝纤维化分期和基线人体测量和临床特征如何，但仅 F4 患者的糖化血红蛋白显著下降。
糖尿病患者 HCV 清除与脂质谱恶化有关，这可能会影响未来的心血管风险。需要对所有 HCV 清除后的糖尿病患者进行心血管危险因素的全面监测。
