Hepatic fibrosis changes in patients with chronic hepatitis C infection who respond to direct-acting antivirals

IF 1.5 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Annals of Saudi Medicine Pub Date : 2022-03-01 DOI:10.5144/0256-4947.2022.89

K. Alswat, Fahad Al-Sohaibani, A. Khathlan, Ahmad Bashmail, M. Alanazi, A. Kurdi, Abdul Hakim Almakadma, W. Al-Hamoudi

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引用次数: 1

Abstract

BACKGROUND: Clearance of hepatitis C virus (HCV) can potentially slow or reverse liver fibrosis and cirrhosis. Studies of fibrosis changes after treatment with direct-acting antivirals (DAAs) are limited. OBJECTIVES: We aimed to assess the impact of DAAs on fibrosis in HCV treatment responders. DESIGN: Retrospective cohort study. SETTING: Tertiary care centers. PATIENTS AND METHODS: This study included adult patients who received DAA treatment for HCV (naïve and experienced) from June 2015 to January 2019 who were treatment responders. Biochemical and hematological data and noninvasive fibrosis markers were recorded at baseline and follow-up. MAIN OUTCOME MEASURES: Aspartate aminotransferase/platelet ratio index (APRI), fibrosis-4 score (FIB-4) and liver stiffness measurements (LSM) at baseline and follow-up. SAMPLE SIZE AND CHARACTERISTICS: 172 HCV treatment responders, mean (SD) age 54.1 (14.1) and body mass index 28.8 (6.5) kg/m2 at baseline; 96 (55.8%) were females. RESULTS: Fifty-eight (33.7%) patients were HCV treatment-experienced. Most patients were genotype 4 (n=125, 73%) and the mean follow-up was 141 (57.9) weeks. Compared with baseline, changes in alanine aminotransferase (P<.001), aspartate aminotransferase (P<.001), and albumin (P=.01) were statistically significant. Changes in LSM (15.09 kPa [11.4] vs. 10.19 kPa [7.4], P<.001), APRI (0.81 [0.7] vs. 0.34 [0.2], P<.001), and FIB-4 (1.99 [1.4) vs.1.35 [0.9], P<.001), and AST/ALT ratio (0.86 [0.32] vs. 0.95 [0.41], P=.015) were statistically significant. Differences in many of the same parameters were statistically significant between patients with low fibrosis (F0-F1) (n=59, 34.3%) and significant fibrosis (≥F2) (n=113, 65.7%). CONCLUSIONS: Our findings confirm that clearance of HCV with DAAs is associated with significant improvement in fibrosis as assessed by noninvasive liver fibrosis measures, which supports the concept of post-treatment fibrosis regression. Long follow-up studies are needed to assess the impact on morbidity and mortality. LIMITATIONS: Absence of histological correlation with these noninvasive scores. No assessment of fibrosis changes based on HCV geno-type or treatment regimen. CONFLICT OF INTEREST: None.

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对直接作用抗病毒药物有反应的慢性丙型肝炎患者的肝纤维化变化

背景：清除丙型肝炎病毒（HCV）可能减缓或逆转肝纤维化和肝硬化。对直接作用抗病毒药物（DAAs）治疗后纤维化变化的研究有限。目的：我们旨在评估DAAs对HCV治疗应答者纤维化的影响。设计：回顾性队列研究。单位：三级护理中心。患者和方法：本研究包括2015年6月至2019年1月接受丙型肝炎DAA治疗的成年患者（幼稚且有经验），他们是治疗应答者。在基线和随访时记录生化和血液学数据以及无创纤维化标志物。主要观察指标：基线和随访时的天冬氨酸转氨酶/血小板比值指数（APRI）、纤维化-4评分（FIB-4）和肝硬度测量（LSM）。样本量和特征：172名HCV治疗应答者，基线时平均（SD）年龄54.1（14.1），体重指数28.8（6.5）kg/m2；女性96例（55.8%）。结果：58例（33.7%）患者有HCV治疗经验。大多数患者为基因型4（n=125，73%），平均随访141（57.9）周。与基线相比，丙氨酸转氨酶（P<.001）、天冬氨酸转氨酶（P<.001）和白蛋白（P=.01）的变化具有统计学意义。LSM（15.09 kPa[11.4]vs.10.19 kPa[7.4]，P<.001）、APRI（0.81[0.7]vs.0.34[0.2]，P<0.001）、FIB-4（1.99[1.4）vs.1.35[0.9]，P<.001）和AST/ALT比率（0.86[0.32]vs.0.95[0.41]，P=.015）的变化具有统计学意义。在低纤维化（F0-F1）（n=59，34.3%）和显著纤维化（≥F2）（n=113，65.7%）患者之间，许多相同参数的差异具有统计学意义，这支持了治疗后纤维化消退的概念。需要进行长期随访研究，以评估对发病率和死亡率的影响。局限性：与这些非侵入性评分缺乏组织学相关性。没有根据HCV基因型或治疗方案评估纤维化变化。利益冲突：无。

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来源期刊

Annals of Saudi Medicine 医学-医学：内科

CiteScore

2.80

自引率

0.00%

发文量

审稿时长

4-8 weeks

期刊介绍： The Annals of Saudi Medicine (ASM) is published bimonthly by King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. We publish scientific reports of clinical interest in English. All submissions are subject to peer review by the editorial board and by reviewers in appropriate specialties. The journal will consider for publication manuscripts from any part of the world, but particularly reports that would be of interest to readers in the Middle East or other parts of Asia and Africa. Please go to the Author Resource Center for additional information.