Cossiga Valentina, La Civita Evelina, Bruzzese Dario, Guarino Maria, Fiorentino Andrea, Sorrentino Rosanna, Pontillo Giuseppina, Vallefuoco Luca, Brusa Stefano, Montella Emma, Terracciano Daniela, Morisco Filomena, Portella Giuseppe
Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy.
Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy.
Front Pharmacol. 2022 Aug 17;13:891398. doi: 10.3389/fphar.2022.891398. eCollection 2022.
In more than 90% of chronic viral hepatitis C (HCV) patients treated with direct-acting antiviral agents (DAAs), a sustained viral response (SVR) was observed. Unfortunately, there are subgroups of subjects who display enduring liver fibrosis and are at high risk of developing hepatocellular carcinoma (HCC). Thus, liver fibrosis evaluation during the follow-up of these patients plays a pivotal role. The gold standard to evaluate hepatic fibrosis is liver biopsy, which is an invasive procedure. Imaging techniques and serum biomarkers have been proposed as safer and cheaper procedures. In this study, we evaluated the concordance of transient elastography (TE) with ELF score ( enhanced liver fibrosis) in a cohort of patients with HCV before and after direct-acting antiviral (DAAs) treatment. ELF score has been validated in other chronic liver diseases; the evidence is not available in HCV patients treated with DAAs. We prospectively recruited all consecutive HCV patient candidates for DAAs therapy at the University of Naples "Federico II" between April 2015 and July 2016. TE and ELF scores were assessed at baseline, at SVR24, and at SVR48. One-hundred-nineteen patients were treated with DAAs, and 94.1% of them reached SVR. A total of 55.5% of patients were males with a mean age of 64.7 ± 9.6 years. TE results revealed that 12 patients (10%) had F1-2 mild/moderate fibrosis, and 107 (90%) had F3-4 advanced fibrosis. At baseline, SVR24, and SVR48, the concordance between ELF test and TE was poor: 0.11 ( = 0.086), 0.15 ( = 0.124), and 0.034 ( = 0.002), respectively. However, at SVR24 and SVR48, both methods showed a significant amelioration of liver fibrosis compared to baseline ( < 0.001). In addition, both ELF index and TE were significantly associated with portal hypertension at baseline, but not with varices and ascites. Our findings suggested that ELF test could predict changes in liver fibrosis, independently of TE. In case of TE unavailability, ELF score could represent an appropriate tool. Notably, in the context of the COVID-19 pandemic, ELF testing should be encouraged to reduce unnecessary access to the hospital and prolonged physical contact.
在接受直接抗病毒药物（DAA）治疗的慢性丙型肝炎（HCV）患者中，超过90%的患者实现了持续病毒学应答（SVR）。不幸的是，有一部分患者存在持续性肝纤维化，并有发展为肝细胞癌（HCC）的高风险。因此，在这些患者的随访过程中进行肝纤维化评估起着关键作用。评估肝纤维化的金标准是肝活检，但这是一种侵入性检查。影像学技术和血清生物标志物已被提出作为更安全、更便宜的检查方法。在本研究中，我们评估了瞬时弹性成像（TE）与ELF评分（增强肝纤维化）在一组接受直接抗病毒（DAA）治疗前后的HCV患者中的一致性。ELF评分已在其他慢性肝病中得到验证；但在接受DAA治疗的HCV患者中尚无相关证据。我们前瞻性地招募了2015年4月至2016年7月期间在那不勒斯“费德里科二世”大学所有连续入选接受DAA治疗的HCV患者。在基线、SVR24和SVR48时评估TE和ELF评分。119例患者接受了DAA治疗，其中94.1%的患者实现了SVR。共有55.5%的患者为男性，平均年龄为64.7±9.6岁。TE结果显示，12例患者（10%）有F1-2级轻度/中度纤维化，107例（90%）有F3-4级重度纤维化。在基线、SVR24和SVR48时，ELF检测与TE之间的一致性较差：分别为0.11（P = 0.086）、0.15（P = 0.124）和0.034（P = 0.002）。然而，在SVR24和SVR48时，与基线相比，两种方法均显示肝纤维化有显著改善（P < 0.001）。此外，在基线时，ELF指数和TE均与门静脉高压显著相关，但与静脉曲张和腹水无关。我们的研究结果表明，ELF检测可独立于TE预测肝纤维化的变化。在无法进行TE检测的情况下，ELF评分可能是一种合适的工具。值得注意的是，在COVID-19大流行的背景下，应鼓励进行ELF检测，以减少不必要的医院就诊和长时间的身体接触。
