Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital; College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan.
Faculty of Internal Medicine and Hepatitis Research Center, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Clin Mol Hepatol. 2024 Oct;30(4):883-894. doi: 10.3350/cmh.2024.0414. Epub 2024 Jul 29.
BACKGROUND/AIMS: Steatotic liver disease (SLD) is a common manifestation in chronic hepatitis C (CHC). Metabolic alterations in CHC are associated with metabolic dysfunction-associated steatotic liver disease (MASLD). We aimed to elucidate whether hepatitis C virus (HCV) eradication mitigates MASLD occurrence or resolution.
We enrolled 5,840 CHC patients whose HCV was eradicated by direct-acting antivirals in a nationwide HCV registry. MASLD and the associated cardiometabolic risk factors (CMRFs) were evaluated at baseline and 6 months after HCV cure.
There were 2,147 (36.8%) patients with SLD, and 1,986 (34.0%) of them met the MASLD criteria before treatment. After treatment, HbA1c (6.0% vs. 5.9%, P<0.001) and BMI (24.8 kg/m2 vs. 24.7 kg/m2, P<0.001) decreased, whereas HDL-C (49.1 mg/dL vs. 51.9 mg/dL, P<0.001) and triglycerides (102.8 mg/dL vs. 111.9 mg/dL, P<0.001) increased significantly. The proportion of patients with SLD was 37.5% after HCV eradication, which did not change significantly compared with the pretreatment status. The percentage of the patients who had post-treatment MASLD was 34.8%, which did not differ significantly from the pretreatment status (P=0.17). Body mass index (BMI) (odds ratio [OR] 0.89; 95% confidence intervals [CI] 0.85-0.92; P<0.001) was the only factor associated with MASLD resolution. In contrast, unfavorable CMRFs, including BMI (OR 1.10; 95% CI 1.06-1.14; P<0.001) and HbA1c (OR 1.19; 95% CI 1.04-1.35; P=0.01), were independently associated with MASLD development after HCV cure.
HCV eradication mitigates MASLD in CHC patients. CMRF surveillance is mandatory for CHC patients with metabolic alterations, which are altered after HCV eradication and predict the evolution of MASLD.
背景/目的：脂肪性肝病（SLD）是慢性丙型肝炎（CHC）的常见表现。CHC 中的代谢改变与代谢相关脂肪性肝病（MASLD）有关。我们旨在阐明丙型肝炎病毒（HCV）的清除是否减轻 MASLD 的发生或缓解。
我们在全国 HCV 登记处招募了 5840 名通过直接作用抗病毒药物清除 HCV 的 CHC 患者。在 HCV 治愈后 6 个月评估 MASLD 和相关的代谢相关心血管危险因素（CMRFs）。
有 2147 名（36.8%）患者患有 SLD，其中 1986 名（34.0%）患者在治疗前符合 MASLD 标准。治疗后，HbA1c（6.0% vs. 5.9%，P<0.001）和 BMI（24.8 kg/m2 vs. 24.7 kg/m2，P<0.001）降低，而 HDL-C（49.1 mg/dL vs. 51.9 mg/dL，P<0.001）和甘油三酯（102.8 mg/dL vs. 111.9 mg/dL，P<0.001）显著增加。HCV 清除后 SLD 患者的比例为 37.5%，与治疗前相比无显著变化。治疗后 MASLD 患者的比例为 34.8%，与治疗前无显著差异（P=0.17）。体重指数（BMI）（比值比[OR]0.89；95%置信区间[CI]0.85-0.92；P<0.001）是唯一与 MASLD 缓解相关的因素。相比之下，BMI（OR 1.10；95%CI 1.06-1.14；P<0.001）和 HbA1c（OR 1.19；95%CI 1.04-1.35；P=0.01）等不利的 CMRF 与 HCV 治愈后 MASLD 的发生独立相关。
HCV 清除减轻了 CHC 患者的 MASLD。代谢改变的 CHC 患者必须进行 CMRF 监测，这些改变在 HCV 清除后发生，并预测 MASLD 的发展。
