直接抗病毒治疗后丙型肝炎病毒相关代偿期和失代偿期肝硬化患者胃食管静脉曲张相关事件的影响因素
Factors involved in gastroesophageal varix-related events in patients with hepatitis C virus-related compensated and decompensated cirrhosis after direct-acting antiviral therapy.
作者信息
Tahata Yuki, Hikita Hayato, Mochida Satoshi, Enomoto Nobuyuki, Kawada Norifumi, Ido Akio, Miki Daiki, Kurosaki Masayuki, Yoshiji Hitoshi, Sakamori Ryotaro, Kuroda Hidekatsu, Yatsuhashi Hiroshi, Yamashita Taro, Hiasa Yoichi, Kato Naoya, Miyaaki Hisamitsu, Ueno Yoshiyuki, Itoh Yoshito, Matsuura Kentaro, Takami Taro, Asahina Yasuhiro, Suda Goki, Akuta Norio, Tateishi Ryosuke, Nakamoto Yasunari, Kakazu Eiji, Terai Shuji, Shimizu Masahito, Miyazaki Masanori, Nozaki Yasutoshi, Sobue Satoshi, Yano Hiroki, Miyaki Tomokatsu, Moriuchi Akihiro, Hori Takeshi, Shirai Kumiko, Murai Kazuhiro, Saito Yoshinobu, Kodama Takahiro, Tatsumi Tomohide, Yamada Tomomi, Takehara Tetsuo
机构信息
Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
Department of Gastroenterology and Hepatology, Saitama Medical University, Saitama, Japan.
出版信息
Hepatol Res. 2024 Oct 29. doi: 10.1111/hepr.14131.
AIM
The incidence of and factors involved in gastroesophageal varix-related events in hepatitis C virus-related cirrhosis patients, including decompensated cirrhosis, after direct-acting antiviral therapy are unclear.
METHODS
We conducted a multicenter study using prospective data from 478 hepatitis C virus-related cirrhosis patients treated with direct-acting antiviral therapy from February 2019 to December 2021 at 33 Japanese hospitals. Gastroesophageal varices were classified as F1 (small-caliber), F2 (moderately enlarged), or F3 (markedly enlarged) according to the Japanese criteria. Patients without varix or with F1 without red color signs were defined as low-risk varix, and patients with ≥F2 or red color signs or a history of rupture were defined as high-risk varix. Varix-related events were defined as prophylactic treatment or rupture of gastroesophageal varix.
RESULTS
The median age was 70 years, 43% of patients had decompensated cirrhosis, and 16% had high-risk varices (13% in compensated and 33% in decompensated, p < 0.001). Sustained virologic response rates were 94.9% for compensated cirrhosis and 91.3% for decompensated cirrhosis (p = 0.120). Across 35.7 months, 25 patients received prophylactic treatment, and four experienced varix rupture. The 3-year incidence rate of varix-related events was 6.2% (3.5% in compensated and 9.9% in decompensated, p = 0.001). In the multivariate analysis, high-risk varix (p < 0.001), high baseline gamma-glutamyl transpeptidase levels (p < 0.001), and virologic failure (p = 0.004) were significantly involved in varix-related events.
CONCLUSIONS
The cumulative incidence rate of varix-related events was significantly higher in decompensated cirrhosis than in compensated cirrhosis. Baseline varix status, baseline gamma-glutamyl transpeptidase levels, and virologic response were related to varix-related events after direct-acting antiviral therapy.
目的
在接受直接抗病毒治疗后的丙型肝炎病毒相关性肝硬化患者中，包括失代偿期肝硬化患者，胃食管静脉曲张相关事件的发生率及相关因素尚不清楚。
方法
我们进行了一项多中心研究，使用了2019年2月至2021年12月期间在33家日本医院接受直接抗病毒治疗的478例丙型肝炎病毒相关性肝硬化患者的前瞻性数据。根据日本标准，胃食管静脉曲张分为F1（小口径）、F2（中度扩大）或F3（明显扩大）。无静脉曲张或有F1且无红色征的患者被定义为低风险静脉曲张，有≥F2或红色征或有破裂史的患者被定义为高风险静脉曲张。静脉曲张相关事件定义为胃食管静脉曲张的预防性治疗或破裂。
结果
中位年龄为70岁，43%的患者患有失代偿期肝硬化，16%的患者有高风险静脉曲张（代偿期为13%，失代偿期为33%，p<0.001）。代偿期肝硬化的持续病毒学应答率为94.9%，失代偿期肝硬化为91.3%（p=0.120）。在35.7个月的时间里，25例患者接受了预防性治疗，4例发生了静脉曲张破裂。静脉曲张相关事件的3年发生率为6.2%（代偿期为3.5%，失代偿期为9.9%，p=0.001）。在多变量分析中，高风险静脉曲张（p<0.001）、基线γ-谷氨酰转肽酶水平高（p<0.001）和病毒学失败（p=0.004）与静脉曲张相关事件显著相关。
结论
失代偿期肝硬化患者静脉曲张相关事件的累积发生率显著高于代偿期肝硬化患者。基线静脉曲张状态、基线γ-谷氨酰转肽酶水平和病毒学应答与直接抗病毒治疗后的静脉曲张相关事件有关。
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