Iwamoto Takayuki, Nozaki Yasutoshi, Inoue Takanori, Suda Takahiro, Mizumoto Rui, Arimoto Yuki, Ohta Takashi, Yamaguchi Shinjiro, Ito Yoshiki, Sudo Yoshiko, Yoshimura Michiko, Kai Machiko, Sasaki Yoichi, Tahata Yuki, Hikita Hayato, Takehara Tetsuo, Hagiwara Hideki
Department of Gastroenterology and Hepatology, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan.
Department of Diagnostic Pathology, Kansai Rosai Hospital, Hyogo, Japan.
J Gastroenterol. 2025 Feb;60(2):197-209. doi: 10.1007/s00535-024-02165-0. Epub 2024 Nov 25.
The histological improvement in liver fibrosis in patients with hepatitis C who achieved a sustained virological response (SVR) to direct-acting antiviral (DAA) treatment has not been comprehensively investigated. Therefore, we assessed the histological changes in liver fibrosis among patients with hepatitis C who underwent long-term follow-up after achieving SVR to treatment with DAA.
This retrospective study enrolled 71 patients with hepatitis C who achieved SVR to treatment with DAA. Changes in histological liver fibrosis and fibrosis biomarkers (hyaluronic acid, type 4 collagen 7S, Mac-2 binding protein glycosylation isomer, autotaxin, and Fibrosis-4 index) were assessed before and 5 years after treatment. Transient elastography using the FibroScan® device was performed 5 years after treatment. Advanced fibrosis and cirrhosis were defined as Ishak fibrosis scores of ≥ 4 and ≥ 5, respectively.
Histological liver fibrosis significantly regressed after SVR. Fibrosis biomarkers were significantly reduced after SVR. Transient elastography was the most helpful after evaluating the predictive performance of advanced fibrosis and cirrhosis after SVR, with an area under the receiver operating characteristic curve of 0.965 and a cut-off value of 6.75 kPa. The cut-off values of serum fibrosis biomarkers for identifying advanced fibrosis and cirrhosis after SVR were lower than those before treatment.
Long-term SVR to treatment with DAA ameliorated histological liver fibrosis. Noninvasive tests helped predict the degree of liver fibrosis after SVR, but their cut-off values should be redefined to avoid underestimation of liver fibrosis.
对于接受直接抗病毒（DAA）治疗并获得持续病毒学应答（SVR）的丙型肝炎患者，其肝纤维化的组织学改善情况尚未得到全面研究。因此，我们评估了接受DAA治疗获得SVR后进行长期随访的丙型肝炎患者肝纤维化的组织学变化。
这项回顾性研究纳入了71例接受DAA治疗获得SVR的丙型肝炎患者。在治疗前和治疗后5年评估肝组织纤维化和纤维化生物标志物（透明质酸、4型胶原7S、Mac-2结合蛋白糖基化异构体、自分泌运动因子和纤维化-4指数）的变化。治疗后5年使用FibroScan®设备进行瞬时弹性成像检查。将高级纤维化和肝硬化分别定义为Ishak纤维化评分≥4分和≥5分。
SVR后肝组织纤维化显著消退。SVR后纤维化生物标志物显著降低。在评估SVR后高级纤维化和肝硬化的预测性能时，瞬时弹性成像最有帮助，受试者操作特征曲线下面积为0.965，截断值为6.75 kPa。SVR后用于识别高级纤维化和肝硬化的血清纤维化生物标志物的截断值低于治疗前。
长期接受DAA治疗获得SVR可改善肝组织纤维化。非侵入性检查有助于预测SVR后的肝纤维化程度，但应重新定义其截断值以避免低估肝纤维化。
