Kristjánsson Smári Freyr, Olafsson Sigurdur, Gottfredsson Magnús, Love Thorvardur Jon, Björnsson Einar Stefán
Faculty of Medicine, University of Iceland, 101 Reykjavik, Iceland.
Division of Gastroenterology and Hepatology, Landspitali-The National University Hospital of Iceland, 101 Reykjavik, Iceland.
J Clin Med. 2025 Jun 5;14(11):3982. doi: 10.3390/jcm14113982.
Direct-acting antiviral (DAA) therapy has been highly successful in treating chronic hepatitis C (CHC). The nationwide Treatment as Prevention of Hepatitis C (TraP HepC) initiative that was launched in Iceland in 2016 utilized liver stiffness measurements (LSM) to assess liver fibrosis at baseline and follow-up. We aimed to determine changes in liver stiffness among patients following treatment with DAAs and evaluate risk factors associated with hepatic fibrosis. Eligible CHC patients with liver stiffness of >9.5 kilopascals (kPa) before DAA treatment were invited for a follow-up visit in 2024. Risk factors for cirrhosis were registered, LSM performed, and liver enzymes, blood lipids, and glucose levels measured. Changes in liver stiffness were compared to baseline measurements, and correlations with risk factors were analyzed. A total of 96 patients had LSMs > 9.5 kPa at treatment initiation. During the follow-up period, 61 were eligible for participation, 38 consented, and 34 (35%) died. The total follow-up was 258.3 person-years. The median follow-up period between measurements was 7.1 years. The median liver stiffness decreased from 17.2 kPa to 7.3 kPa ( < 0.01), and 80% of those with cirrhosis (>12.5 kPa) regressed to non-cirrhotic values. High BMI and daily alcohol consumption were significantly associated with increased liver stiffness in 8% of patients. In this single-arm, pre-post pilot study, liver stiffness regressed significantly in 92% of patients who were cured of CHC. Patients with other persistent risk factors following cure, such as obesity and alcohol abuse, were the only patients who had increased liver stiffness at the end of follow-up.
直接抗病毒（DAA）疗法在治疗慢性丙型肝炎（CHC）方面取得了巨大成功。2016年在冰岛启动的全国性丙型肝炎治疗即预防（TraP HepC）倡议利用肝脏硬度测量（LSM）在基线和随访时评估肝纤维化。我们旨在确定接受DAA治疗的患者肝脏硬度的变化，并评估与肝纤维化相关的危险因素。邀请在DAA治疗前肝脏硬度>9.5千帕（kPa）的符合条件的CHC患者在2024年进行随访。记录肝硬化的危险因素，进行LSM测量，并测量肝酶、血脂和血糖水平。将肝脏硬度的变化与基线测量值进行比较，并分析与危险因素的相关性。共有96例患者在治疗开始时LSM>9.5 kPa。在随访期间，61例符合参与条件，38例同意参与，34例（35%）死亡。总随访时间为258.3人年。两次测量之间的中位随访期为7.1年。肝脏硬度中位数从17.2 kPa降至7.3 kPa（<0.01），80%的肝硬化患者（>12.5 kPa）恢复到非肝硬化值。高体重指数和每日饮酒与8%的患者肝脏硬度增加显著相关。在这项单臂前后对照的试点研究中，92%治愈CHC的患者肝脏硬度显著下降。治愈后存在其他持续危险因素的患者，如肥胖和酗酒，是随访结束时肝脏硬度增加的唯一患者。
