直接作用抗病毒药物治疗后 HCV 感染患者肝硬度与肝脏相关事件的相关性。
Association between Liver Stiffness and Liver-Related Events in HCV-Infected Patients after Successful Treatment with Direct-Acting Antivirals.
机构信息
Division of Gastroenterology, Department of Medicine, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand.
Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.
出版信息
Medicina (Kaunas). 2023 Mar 18;59(3):602. doi: 10.3390/medicina59030602.
: Direct-acting antivirals (DAAs) are highly effective for the treatment of chronic hepatitis C virus (HCV) infection, but the risk of liver-related events and hepatocellular carcinoma (HCC) remains after successful therapy. We aimed to evaluate post-treatment changes in liver stiffness (LS) and identify a cut-off LS value for predicting such events in chronic HCV-infected patients receiving DAA. : A total of 185 patients who had achieved sustained virologic response (SVR) after DAA therapy were included. Baseline characteristics and laboratory results were retrospectively abstracted. LS was measured by transient elastography at baseline, 12, 24, 48, and 96 weeks after SVR. FIB-4 index was assessed at baseline and 48 weeks after SVR. Development of liver-related events (hepatocellular carcinoma (HCC), portal-hypertension-related decompensation, listing for transplantation, and mortality) after SVR were identified. The association between liver fibrosis and the occurrence of liver-related events was analyzed using Cox regression analysis. : Significant differences in LS values were observed between baseline and 24, 48, 72, and 96 weeks after SVR. FIB-4 index at 48 weeks after SVR was significantly lower than the FIB-4 index at baseline. During the 41.6-month follow-up time, the incidence rates of all liver-related events and HCC were 2.36 and 1.17 per 100 person-years, respectively. Age, LS ≥8 kPa, and FIB-4 ≥1.35 at 48 weeks post-SVR were significantly associated with the occurrence of any liver-related events. By multivariate analysis, LS ≥8 kPa at 48 weeks post-SVR remained significantly associated with any liver-related events, with an adjusted hazard ratio (95%CI) of 5.04 (1.01-25.26), = 0.049. : Despite a significant reduction in LS after SVR, patients with LS ≥8 kPa at 48 weeks after SVR should be regularly monitored for liver-related complications, particularly HCC development.
直接作用抗病毒药物（DAAs）对慢性丙型肝炎病毒（HCV）感染的治疗非常有效，但在成功治疗后，仍存在与肝脏相关的事件和肝细胞癌（HCC）的风险。我们旨在评估治疗后肝硬度（LS）的变化，并确定 DAA 治疗的慢性 HCV 感染患者预测此类事件的 LS 临界值。
共纳入 185 例 DAA 治疗后获得持续病毒学应答（SVR）的患者。回顾性提取基线特征和实验室结果。在 SVR 后 12、24、48 和 96 周，通过瞬时弹性成像测量 LS。在 SVR 后 48 周评估 FIB-4 指数。确定 SVR 后与肝脏相关的事件（肝细胞癌（HCC）、门静脉高压相关失代偿、移植名单和死亡率）的发生情况。使用 Cox 回归分析分析肝纤维化与肝脏相关事件发生之间的关系。
SVR 后 24、48、72 和 96 周，LS 值存在显著差异。SVR 后 48 周的 FIB-4 指数明显低于基线时的 FIB-4 指数。在 41.6 个月的随访期间，所有肝脏相关事件和 HCC 的发生率分别为每 100 人年 2.36 和 1.17 例。年龄、SVR 后 48 周时 LS≥8 kPa 和 FIB-4≥1.35 与任何肝脏相关事件的发生显著相关。多变量分析显示，SVR 后 48 周时 LS≥8 kPa 与任何肝脏相关事件显著相关，调整后的危险比（95%CI）为 5.04（1.01-25.26）， = 0.049。
尽管 SVR 后 LS 显著降低，但 SVR 后 48 周时 LS≥8 kPa 的患者应定期监测肝脏相关并发症，特别是 HCC 发生。
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