直接作用抗病毒药物治疗慢性丙型肝炎患者的持续病毒学应答对葡萄糖参数的影响。
Impact of sustained virologic response on glucose parameters among patients with chronic hepatitis C treated with direct-acting antivirals.
机构信息
Programa de Pós-graduação em Gastroenterologia e Hepatologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil.
Divisão de Gastroenterologia e Hepatologia do Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil.
出版信息
Arch Endocrinol Metab. 2024 May 6;68:e220480. doi: 10.20945/2359-4292-2022-0480.
OBJECTIVE
The aim of this study was to evaluate the glycated hemoglobin (HbA1c) levels before and after sustained virologic response (SVR) and investigate the baseline characteristics associated with improved glycemic control in patients with chronic hepatitis C (CHC) achieving SVR after directacting antivirals (DAA) therapy.
MATERIALS AND METHODS
Consecutive adult patients with CHC who achieved SVR after DAA treatment between January 2016 and December 2017 at Hospital de Clínicas de Porto Alegre (RS, Brazil) were prospectively included. Levels of HbA1c were measured up to 24 weeks before DAA therapy and 12 weeks after SVR. Exclusion criteria were decompensated cirrhosis, HIV and/or hepatitis B virus, liver disease of other etiologies, and/or modification of prediabetes/ type 2 diabetes mellitus (PDM/T2DM) management. The primary outcome was a comparison of HbA1c levels before and after SVR. Secondary outcomes were the baseline variables associated with improved glycemic control.
RESULTS
The study included 207 patients with a mean age of 60.6±10.7 years, of whom 51.7% were women, 56% had cirrhosis, 37.7% had HCV genotype 3, and 54.5% had baseline T2DM or PDM. The median HbA1c level reduced significantly after SVR (5.5%, interquartile range [IQR] 4.9%-6.3%) compared with baseline (5.7%, IQR 5.3%-6.7%; p = 0.01). The baseline characteristics associated with improved HbA1c after SVR were cirrhosis, genotype 3, and age ≤ 60 years.
CONCLUSION
Among patients with CHC, SVR after DAA was associated with HbA1c reduction, particularly in those with cirrhosis, genotype 3, and age ≤ 60 years.
目的
本研究旨在评估慢性丙型肝炎（CHC）患者在获得直接作用抗病毒药物（DAA）治疗后的持续病毒学应答（SVR）前后的糖化血红蛋白（HbA1c）水平，并探讨与 SVR 后血糖控制改善相关的基线特征。
材料与方法
本前瞻性研究纳入了 2016 年 1 月至 2017 年 12 月在巴西阿雷格里港临床医院（RS）接受 DAA 治疗后获得 SVR 的连续成年 CHC 患者。在 DAA 治疗前 24 周和 SVR 后 12 周测量 HbA1c 水平。排除标准为失代偿性肝硬化、HIV 和/或乙型肝炎病毒、其他病因的肝病以及/或改变糖尿病前期/2 型糖尿病（PDM/T2DM）的管理。主要结局为 SVR 前后 HbA1c 水平的比较。次要结局为与血糖控制改善相关的基线变量。
结果
本研究共纳入 207 例患者，平均年龄为 60.6±10.7 岁，其中 51.7%为女性，56%有肝硬化，37.7%为 HCV 基因型 3，54.5%有基线 T2DM 或 PDM。与基线（5.7%，IQR 5.3%-6.7%；p=0.01）相比，SVR 后 HbA1c 水平显著降低（5.5%，IQR 4.9%-6.3%）。与 SVR 后 HbA1c 改善相关的基线特征为肝硬化、基因型 3 和年龄≤60 岁。
结论
在 CHC 患者中，DAA 后的 SVR 与 HbA1c 降低相关，尤其是在有肝硬化、基因型 3 和年龄≤60 岁的患者中。
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