直接作用抗病毒药物根除丙型肝炎病毒对慢性丙型肝炎患者血糖指标的影响——台湾全国丙型肝炎病毒登记研究

Impact of HCV eradication by directly acting antivirals on glycemic indices in chronic hepatitis C patients -a nationwide Taiwan HCV registry.

作者信息

Jang Tyng-Yuan, Huang Chung-Feng, Chang Te-Sheng, Yang Chun-Chi, Lo Ching-Chu, Hung Chao-Hung, Huang Chien-Wei, Chong Lee-Won, Cheng Pin-Nan, Yeh Ming-Lun, Peng Cheng-Yuan, Cheng Chien-Yu, Huang Jee-Fu, Bair Ming-Jong, Lin Chih-Lang, Yang Chi-Chieh, Wang Szu-Jen, Hsieh Tsai-Yuan, Lee Tzong-Hsi, Lee Pei-Lun, Wu Wen-Chih, Lin Chih-Lin, Su Wei-Wen, Yang Sheng-Shun, Wang Chia-Chi, Hu Jui-Ting, Mo Lein-Ray, Chen Chun-Ting, Huang Yi-Hsiang, Chang Chun-Chao, Huang Chia-Sheng, Chen Guei-Ying, Kao Chien-Neng, Tai Chi-Ming, Liu Chun-Jen, Lee Mei-Hsuan, Tsai Pei-Chien, Dai Chia-Yen, Kao Jia-Horng, Lin Han-Chieh, Chuang Wang-Long, Tseng Kuo-Chih, Chen Chi-Yi, Kuo Hsing-Tao, Yu Ming-Lung

机构信息

Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.

Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Ph.D. Program in Translational Medicine, College of Medicine, Kaohsiung Medical University, Academia Sinica, Kaohsiung, Taiwan.

出版信息

J Formos Med Assoc. 2024 Aug 20. doi: 10.1016/j.jfma.2024.08.013.

DOI:10.1016/j.jfma.2024.08.013

PMID:39168745

Abstract

BACKGROUND/AIMS: Hepatitis C virus (HCV) eradication using antiviral agents augments the metabolic profile. Changes in glycated hemoglobin (HbA1c) levels in chronic hepatitis C patients who receive glecaprevir/pibrentasvir (GLE/PIB) remain elusive.

METHODS

Data from 2417 patients treated with GLE/PIB from the Taiwan HCV Registry were analyzed, and pretreatment HbA1c levels were compared with 3-months after the-end-of treatment levels. A sustained virological response (SVR) was defined as undetectable HCV RNA at 12 weeks after the end of treatment. A significant change in HbA1c level was defined as the 75th percentile of the change in the HbA1c level before and after treatment (decrement >0.2%).

RESULTS

Serum HbA1c levels decreased significantly (6.0 vs 5.9%, P < 0.001). Post-treatment HbA1c levels decreased in all subgroups, except in non-SVR patients (5.7 vs 5.7%, P = 0.79). Compared to patients without significant HbA1c improvement (decrement >0.2%), those with HbA1c improvement were older (60.2 vs 58.6 years, P < 0.001), had higher serum creatinine levels (1.9 vs 1.6 mg/dL, P < 0.001), triglycerides (129.8 vs 106.2 mg/dL, P < 0.001), fasting glucose (135.8 vs 104.0 mg/dL, P < 0.001), and pretreatment HbA1c (7.1 vs 5.7%, P < 0.001) and had a higher proportion of male sex (57.9% vs 50.9%, P = 0.003), diabetes (84.3 vs 16.8%, P < 0.001), more advanced stages of chronic kidney disease (CKD) (15.7 vs 11.1 %, P < 0.001), anti-diabetic medication use (47.3 vs 16.4%, P < 0.001) and fatty liver (49.6 vs 38.3 %, P < 0.001). Multivariate analysis revealed that the factors associated with significant HbA1c improvement were age (odds ratio [OR]/95% confidence intervals [CI]: 1.01/1.00-1.02, P = 0.01), HbA1c level (OR/CI: 2.83/2.48-3.24, P < 0.001) and advanced CKD stages (OR/CI: 1.16/1.05-1.28, P = 0.004). If the HbA1c variable was not considered, the factors associated with significant HbA1c improvement included alanine aminotransferase level (OR/CI, 1.002/1.000-1.004, P = 0.01), fasting glucose level (OR/CI: 1.010/1.006-1.013, P < 0.001), and diabetes (OR/CI: 3.35/2.52-4.45, P < 0.001).

CONCLUSIONS

The HbA1c levels improved shortly after HCV eradication using GLE/PIB. The improvement in glycemic control can be generalized to all subpopulations, particularly in patients with a higher baseline HbA1c level or diabetes.

摘要

背景/目的：使用抗病毒药物根除丙型肝炎病毒（HCV）可改善代谢状况。接受 glecaprevir/pibrentasvir（GLE/PIB）治疗的慢性丙型肝炎患者糖化血红蛋白（HbA1c）水平的变化尚不清楚。

方法

分析了台湾 HCV 登记处 2417 例接受 GLE/PIB 治疗患者的数据，并将治疗前 HbA1c 水平与治疗结束后 3 个月的水平进行比较。持续病毒学应答（SVR）定义为治疗结束后 12 周 HCV RNA 检测不到。HbA1c 水平的显著变化定义为治疗前后 HbA1c 水平变化的第 75 百分位数（下降>0.2%）。

结果

血清 HbA1c 水平显著下降（6.0%对 5.9%，P<0.001）。除无 SVR 的患者外，所有亚组的治疗后 HbA1c 水平均下降（5.7%对 5.7%，P = 0.79）。与 HbA1c 无显著改善（下降>0.2%）的患者相比，HbA1c 有改善的患者年龄更大（60.2 岁对 58.6 岁，P<0.001），血清肌酐水平更高（1.9mg/dL 对 1.6mg/dL，P<0.001），甘油三酯水平更高（129.8mg/dL 对 106.2mg/dL，P<0.001），空腹血糖水平更高（135.8mg/dL 对 104.0mg/dL，P<0.001），治疗前 HbA1c 水平更高（7.1%对 5.7%，P<0.001），男性比例更高（57.9%对 50.9%，P = 0.003），糖尿病患者比例更高（84.3%对 16.8%，P<0.001），慢性肾脏病（CKD）晚期比例更高（1