Department of Hepatology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.
Department of Hepatology, Kashiwara Municipal Hospital, 1-7-9 Houzenji, Kashiwara, Osaka, 582-0005, Japan.
J Gastroenterol. 2023 Apr;58(4):394-404. doi: 10.1007/s00535-023-01963-2. Epub 2023 Feb 2.
It is unclear whether hepatocyte function and/or portal hypertension improves if a sustained virologic response (SVR) is achieved with direct-acting antivirals in patients with decompensated hepatitis C-related cirrhosis.
We examined the safety and efficacy of a 12-week course of sofosbuvir/velpatasvir (SOF/VEL) in 20 patients with decompensated hepatitis C-related cirrhosis. We also investigated changes in the hepatocyte receptor index (LHL15) and blood clearance index (HH15) by Tc-99 m-galactosyl human serum albumin scintigraphy, liver stiffness measurement (LSM) by transient elastography, and hepatic venous pressure gradient (HVPG) in patients who achieved an SVR at 24 weeks after treatment (SVR24).
One patient discontinued treatment because of rectal variceal hemorrhage, and 19 patients completed treatment. SVR24 was achieved in 17 patients (89%). Median LHL15 increased from 0.72 pre-treatment to 0.82 after SVR24 (p = 0.012), and median HH15 decreased from 0.82 pre-treatment to 0.76 after SVR24 (p = 0.010). The percentage of patients with LSM ≥ 20 kPa was 90% before treatment and remained at 90% after SVR24. However, the percentage with severe portal hypertension (defined as HVPG ≥ 12 mmHg) decreased from 92% pre-treatment to 58% after SVR24 (p = 0.046). Patients with a decreased HVPG from pre-treatment to after SVR24 had a smaller pre-treatment spleen volume than those with an increased HVPG (median, 252 vs. 537 mL, p = 0.028).
Achieving SVR24 with SOF/VEL treatment in patients with decompensated hepatitis C-related cirrhosis can be expected to improve hepatocyte function and portal hypertension on short-term follow-up.
在失代偿期丙型肝炎相关肝硬化患者中，直接作用抗病毒药物（DAA）实现持续病毒学应答（SVR）后，其肝细胞功能和/或门静脉高压是否改善尚不清楚。
我们研究了在 20 例失代偿期丙型肝炎相关肝硬化患者中使用索磷布韦/维帕他韦（SOF/VEL）12 周疗程的安全性和疗效。我们还通过 Tc-99m 半乳糖白蛋白闪烁扫描、瞬时弹性成像测量的肝硬度（LSM）和肝静脉压力梯度（HVPG），研究了治疗 24 周后达到 SVR 的患者（SVR24）的肝细胞受体指数（LHL15）和血液清除指数（HH15）的变化。
1 例患者因直肠静脉曲张出血而停止治疗，19 例患者完成治疗。17 例（89%）患者达到 SVR24。LHL15 中位数从治疗前的 0.72 增加到 SVR24 后的 0.82（p=0.012），HH15 中位数从治疗前的 0.82 减少到 SVR24 后的 0.76（p=0.010）。治疗前 LSM≥20kPa 的患者比例为 90%，SVR24 后仍为 90%。然而，严重门静脉高压（定义为 HVPG≥12mmHg）的患者比例从治疗前的 92%下降至 SVR24 后的 58%（p=0.046）。与 HVPG 从治疗前到 SVR24 增加的患者相比，HVPG 降低的患者治疗前脾脏体积更小（中位数，252 vs. 537mL，p=0.028）。
在失代偿期丙型肝炎相关肝硬化患者中，SOF/VEL 治疗实现 SVR24，有望在短期随访中改善肝细胞功能和门静脉高压。
