Carotid Intima-media Thickness and Small Dense Low-density Lipoprotein Cholesterol Increase after One Year of Treatment with Direct-acting Antivirals in Patients with Hepatitis C Virus Infection
Carotid Intima-media Thickness and Small Dense Low-density Lipoprotein Cholesterol Increase after One Year of Treatment with Direct-acting Antivirals in Patients with Hepatitis C Virus Infection
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DOI：
10.2169/internalmedicine.1514-18
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发表时间：
2019-01-01
影响因子：
1.2
通讯作者：
Nakao, Kazuhiko
中科院分区：
文献类型：
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作者：
Ichikawa, Tatsuki;Miyaaki, Hisamitsu;Nakao, Kazuhiko
目的治疗丙型肝炎病毒(HCV)感染的直接作用抗病毒药物(DAAs)具有显著的持续病毒应答(SVR)，患者低密度脂蛋白胆固醇(LDL)和总胆固醇水平回升。颈动脉内膜中层厚度(IMT)是评价动脉粥样硬化进程的高重复性和无创性指标，而小密度低密度脂蛋白(SD)水平可用于临床评估动脉粥样硬化的风险。所有患者在24周后都出现了SVR。我们比较了患者在DAA治疗开始时和治疗一年后的代谢特征，包括sdLDL和IMT值。结果治疗1年后，血清sdLDL、%sdLDL(sdLDL/LDL)和低密度脂蛋白水平明显加重，但甘油三酯水平、糖化血红蛋白水平、胰岛素抵抗和体重无明显变化。与治疗开始时相比，一年后最大内中膜厚度增加。男性最大IMT(DMAX-IMT)的差异大于女性；然而，DMAX-IMT与基因型、纤维化、高血压、高脂血症、糖尿病、肥胖和透析状态之间没有相关性。治疗开始及1年后的%sdLDL与DMAX-IMT呈正相关。低密度脂蛋白、甘油三酯、体重指数、胰岛素抵抗和dmax IMT等因素之间无相关性。在单因素和多因素分析中，治疗开始时%sdLDL>；=16%与性别和DMAX-IMT显著相关。结论由于在DAA治疗一年后sdLDL和IMT值加重，因此必须对达到SVR的患者进行动脉粥样硬化的评估。
Objective Direct-acting antivirals (DAAs) for treating hepatitis C virus (HCV) infection exert a significantly high sustained viral response (SVR), and patients experience a rebound increase in low-density lipoprotein cholesterol (LDL) and total cholesterol levels. Carotid intima-media thickness (IMT) is a highly reproducible and non-invasive parameter for assessing the atherosclerotic process, and the small dense (sd) LDL level is useful for clinically evaluating the atherogenic risk.Methods A total of 48 patients with chronic HCV infection were treated with DAAs. All patients exhibited an SVR 24 weeks later. We compared the metabolic profiles of the patients, including the sdLDL and IMT values, at the start of DAA treatment with those after one year of treatment. We verified whether the HCV clearance after the administration of DAAs is associated with the development of atherosclerosis.Results The sdLDL, %sdLDL (sdLDL/LDL), and LDL values were exacerbated after a year of treatment; however, the triglyceride level, glycated hemoglobin level, insulin resistance, and body weight remained unaltered. The max-IMT was increased after a year compared to that at the start of treatment. Differences in the max-IMT (dmax-IMT) were greater in men than in women; however, no correlation was observed between the dmax-IMT and genotype, fibrosis, hypertension, hyperlipidemia, diabetes, obesity, and dialysis status. The %sdLDL at the start and a year later was positively correlated with the dmax-IMT. No correlation was observed among various factors including the LDL, triglyceride, body mass index, insulin resistance and dmaxIMT. In uni-and multivariate analyses, a significant correlation was observed between %sdLDL >= 16%at the start of treatment and the sex and dmax-IMT.Conclusion Because the sdLDL and IMT values were exacerbated after a year of DAA treatment, atherosclerosis must be evaluated in patients achieving an SVR.