Department of Internal Medicine, Virginia Commonwealth University Health System, Richmond, Virginia, USA.
Department of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University Health System, Richmond, Virginia, USA.
J Viral Hepat. 2023 Jan;30(1):73-78. doi: 10.1111/jvh.13763. Epub 2022 Nov 2.
Chronic hepatitis C virus (HCV) is common. Treatment with direct acting antivirals (DAA) result in high sustained virologic response (SVR) associated with normalization of alanine aminotransferase (ALT). However, abnormal ALT after SVR has been observed. Since fatty liver disease can co-exist with HCV, its impact on abnormal ALT after SVR is unknown. This was a retrospective case-control analysis evaluating those with SVR and baseline fatty liver disease by transient elastography defined by controlled attenuated parameter (CAP) was performed. Abnormal ALT was defined as >1.5 ULN. The primary analysis compared abnormal ALT at SVR-12 and beyond in those with and without fatty liver disease. Six-hundred and ninety-three patients with SVR-12 were evaluated. Abnormal ALT at SVR-12 was present in 8.2% and was similar in those with and without fatty liver disease. Abnormal ALT at SVR-12 was associated with atrial fibrillation (p = .02), CAP (p = .047), age (p = .08), baseline ALT (p = .008), BMI (p = .002) and obesity (p = .02). On multivariate analysis, only BMI was associated with abnormal ALT at SVR-12 (p = .017). ALT at follow-up after SVR-12 was available in 264 patients. In those with initial normal ALT (n = 244), 11.5% had a delayed abnormal ALT and in those with initial abnormal ALT (n = 20), 47% remained abnormal while 53% normalized. Abnormal ALT after SVR following treatment with DAA is uncommon and related to increased BMI, but not related to underlying fatty liver disease assessed by CAP. The pattern of ALT can vary, and long-term follow-up is needed to assess the clinical impact of abnormal ALT after SVR.
慢性丙型肝炎病毒（HCV）很常见。直接作用抗病毒药物（DAA）治疗可导致高持续病毒学应答（SVR），同时丙氨酸氨基转移酶（ALT）恢复正常。然而，在 SVR 后观察到 ALT 异常。由于脂肪肝疾病可能与 HCV 共存，其对 SVR 后异常 ALT 的影响尚不清楚。本研究是一项回顾性病例对照分析，通过受控衰减参数（CAP）定义的瞬时弹性成像评估 SVR 时伴有基线脂肪肝疾病的患者。异常 ALT 定义为>1.5ULN。主要分析比较了 SVR-12 时及以后伴有和不伴有脂肪肝疾病患者的异常 ALT。共评估了 693 例 SVR-12 患者。在 SVR-12 时，异常 ALT 的发生率为 8.2%，在伴有和不伴有脂肪肝疾病的患者中无差异。SVR-12 时的异常 ALT 与心房颤动（p=0.02）、CAP（p=0.047）、年龄（p=0.08）、基线 ALT（p=0.008）、BMI（p=0.002）和肥胖（p=0.02）有关。多变量分析显示，只有 BMI 与 SVR-12 时的异常 ALT 有关（p=0.017）。SVR-12 后有 264 例患者进行了 ALT 随访。在初始 ALT 正常的患者（n=244）中，11.5%出现延迟性异常 ALT，在初始 ALT 异常的患者（n=20）中，47%仍异常，53%恢复正常。DAA 治疗后 SVR 后的异常 ALT 并不常见，与 BMI 增加有关，但与 CAP 评估的潜在脂肪肝疾病无关。ALT 的模式可能会有所不同，需要长期随访以评估 SVR 后异常 ALT 的临床影响。
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