Department of Medicine, National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway.
Department of Medicine, Haukeland University Hospital, Bergen, Norway.
Scand J Gastroenterol. 2024 Oct;59(10):1184-1191. doi: 10.1080/00365521.2024.2388691. Epub 2024 Sep 1.
Hepatitis C virus (HCV) is a major cause of chronic liver disease, in which liver stiffness increases. Liver stiffness measurements (LSM) are therefore essential in diagnosing liver diseases and predicting disease development. The study objective was to perform a comprehensive prospective assessment of the liver before, after and 4 years after treatment for HCV, including an assessment of the long-term outcome of fibrosis, steatosis and inflammation.
Patients eligible for HCV treatment were included prospectively in 2018 ( = 47). Liver stiffness was measured using transient elastography and 2D shear-wave elastography (SWE). Blood tests, B-mode ultrasound (US) and SWE, were performed before, after (end of treatment [EOT]), 3 months after (EOT3) and 4 years after treatment (4Y). At the final visit, we added attenuation imaging and shear-wave dispersion slope (SWDS) measurements to assess steatosis and inflammation. Three months after treatment, the sustained virologic response rate was 93%. The median liver stiffness for baseline, EOT, EOT3 and 4Y was 8.1, 5.9, 5.6 and 6.3 kPa, respectively. There was a significant reduction in liver stiffness from baseline to EOT, and from EOT to EOT3. After 4 years, the mean attenuation coefficient (AC) was 0.58 dB/cm/MHz, and the mean SWDS value was 14.3 (m/s)/kHz.
The treatment for HCV was highly effective. Measurements of liver stiffness decreased significantly after treatment and remained low after 4 years. AC measurements indicated low levels of liver steatosis. Shear-wave dispersion values indicated inflammation of the liver, but the clinical implication is undetermined and should be explored in larger studies.Clinicaltrials.gov: NCT03434470.
AC: attenuation coefficient; APRI: aspartate aminotransferase to platelet ratio index; ATI: attenuation imaging; cACLD: compensated advanced chronic liver disease; CAP: controlled attenuation parameter; FIB-4: Fibrosis-4 Index for liver fibrosis; HCC: hepatocellular carcinoma; LSM: liver stiffness measurement; NAFLD: non-alcoholic fatty liver disease; NASH: non-alcoholic steatohepatitis; SWDS: shear-wave dispersion slope; SWE: shear-wave elastography; US: ultrasound.
丙型肝炎病毒（HCV）是慢性肝病的主要病因，在慢性肝病中，肝脏硬度增加。因此，肝脏硬度测量（LSM）对于诊断肝病和预测疾病进展至关重要。本研究的目的是在 HCV 治疗前、治疗后和治疗后 4 年对肝脏进行全面的前瞻性评估，包括评估纤维化、脂肪变性和炎症的长期结局。
2018 年前瞻性纳入符合 HCV 治疗条件的患者（=47 例）。使用瞬时弹性成像和二维剪切波弹性成像（SWE）测量肝脏硬度。在治疗前（基线）、治疗结束时（EOT）、EOT3 和治疗后 4 年后（4Y）进行血液检查、B 型超声（US）和 SWE。在最后一次就诊时，我们添加衰减成像和剪切波频散斜率（SWDS）测量以评估脂肪变性和炎症。治疗后 3 个月时，持续病毒学应答率为 93%。基线、EOT、EOT3 和 4Y 的中位肝脏硬度分别为 8.1、5.9、5.6 和 6.3 kPa。从基线到 EOT 和从 EOT 到 EOT3，肝脏硬度均显著降低。4 年后，平均衰减系数（AC）为 0.58 dB/cm/MHz，平均 SWDS 值为 14.3（m/s）/kHz。
HCV 的治疗非常有效。治疗后肝脏硬度显著下降，4 年后仍保持较低水平。AC 测量值表明肝脏脂肪变性程度较低。SWDS 值表明肝脏炎症，但临床意义尚未确定，需要在更大的研究中进一步探索。
NCT03434470。
AC：衰减系数；APRI：天冬氨酸氨基转移酶与血小板比值指数；ATI：衰减成像；cACLD：代偿性晚期慢性肝病；CAP：受控衰减参数；FIB-4：肝纤维化 4 指数；HCC：肝细胞癌；LSM：肝脏硬度测量；NAFLD：非酒精性脂肪性肝病；NASH：非酒精性脂肪性肝炎；SWDS：剪切波频散斜率；SWE：剪切波弹性成像；US：超声。
