直接作用抗病毒治疗后代谢功能障碍对纤维化消退的不良影响：一项针对慢性丙型肝炎的多中心研究

IF 14 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Clinical and Molecular Hepatology Pub Date : 2025-01-09 DOI:10.3350/cmh.2024.0904

Tom Ryu, Young Chang, Soung Won Jeong, Jeong-Ju Yoo, Sae Hwan Lee, Sang Gyune Kim, Young Seok Kim, Hong Soo Kim, Seung Up Kim, Jae Young Jang

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引用次数: 0

摘要

背景/目的：直接作用抗病毒药物（DAAs）能有效根除丙型肝炎病毒（HCV）。本研究探讨代谢功能障碍是否影响慢性丙型肝炎（CHC）患者DAA治疗后纤维化消退的可能性。方法：这项多中心回顾性研究纳入了8819例诊断为CHC的患者，这些患者在2014年1月至2022年12月期间接受了DAAs治疗并实现了持续病毒学应答（SVR）。纤维化回归被定义为无创肝纤维化替代物减少20%，如通过振动控制瞬时弹性成像（VCTE）和纤维化-4 （FIB-4）评分测量的肝脏硬度（LS）。高胆固醇血症（h-TC）定义为bb0 ~ 200mg /dL。结果：研究人群的中位年龄为59.6岁，以男性患者为主（n = 4713，占57.3%）。1型、2型和其他基因型分别在3872例（46.2%）、3487例（41.6%）和1024例（12.2%）患者中得到证实。1442例（17.2%）患者存在糖尿病（DM），中位LS为7.50 kPa（四分位数范围为5.30-12.50）。多因素分析显示，DM和pre-DAA h-TC的存在与VCTE纤维化消退的可能性降低独立相关。此外，pre-DAA h-TC与FIB-4纤维化消退的可能性降低独立相关。结论：DAA治疗后达到SVR的CHC患者，代谢功能障碍对纤维化消退有不利影响。

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Adverse impact of metabolic dysfunction on fibrosis regression following direct-acting antiviral therapy: A multicenter study for chronic hepatitis C.

Background/aims: Direct-acting antivirals (DAAs) effectively eradicate hepatitis C virus (HCV). This study investigated whether metabolic dysfunction influences the likelihood of fibrosis regression after DAA treatment in patients with chronic hepatitis C (CHC).

Methods: This multicenter, retrospective study included 8,819 patients diagnosed with CHC who were treated with DAAs and achieved a sustained virological response (SVR) between January 2014 and December 2022. Fibrosis regression was defined as a 20% reduction in noninvasive surrogates for liver fibrosis, such as liver stiffness (LS) measured by vibration-controlled transient elastography (VCTE) and the fibrosis-4 (FIB-4) score. Hypercholesterolemia (h-TC) were defined as >200 mg/dL.

Results: The median age of the study population was 59.6 years, with a predominance of male patients (n = 4,713, 57.3%). Genotypes 1, 2, and others were confirmed in 3,872 (46.2%), 3,487 (41.6%), and 1,024 (12.2%) patients, respectively. Diabetes mellitus (DM) was present in 1,442 (17.2%) patients and the median LS was 7.50 kPa (interquartile range, 5.30-12.50). Multivariate analysis revealed that the presence of DM and pre-DAA h-TC were independently associated with a decreased probability of fibrosis regression by VCTE Additionally, pre-DAA h-TC was independently associated with a decreased probability of fibrosis regression by the FIB-4.

Conclusions: Metabolic dysfunction has an unfavorable influence on fibrosis regression in patients with CHC who achieve SVR after DAA treatment.

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来源期刊

Clinical and Molecular Hepatology Medicine-Hepatology

CiteScore

15.60

自引率

9.00%

发文量

审稿时长

10 weeks

期刊介绍： Clinical and Molecular Hepatology is an internationally recognized, peer-reviewed, open-access journal published quarterly in English. Its mission is to disseminate cutting-edge knowledge, trends, and insights into hepatobiliary diseases, fostering an inclusive academic platform for robust debate and discussion among clinical practitioners, translational researchers, and basic scientists. With a multidisciplinary approach, the journal strives to enhance public health, particularly in the resource-limited Asia-Pacific region, which faces significant challenges such as high prevalence of B viral infection and hepatocellular carcinoma. Furthermore, Clinical and Molecular Hepatology prioritizes epidemiological studies of hepatobiliary diseases across diverse regions including East Asia, North Asia, Southeast Asia, Central Asia, South Asia, Southwest Asia, Pacific, Africa, Central Europe, Eastern Europe, Central America, and South America. The journal publishes a wide range of content, including original research papers, meta-analyses, letters to the editor, case reports, reviews, guidelines, editorials, and liver images and pathology, encompassing all facets of hepatology.