Impact of sustained virological response on the extrahepatic manifestations of chronic hepatitis C: a meta-analysis
Impact of sustained virological response on the extrahepatic manifestations of chronic hepatitis C: a meta-analysis
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DOI：
10.1136/gutjnl-2018-316234
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发表时间：
2018-11-01
期刊：
影响因子：
24.5
通讯作者：
Saadoun, David
中科院分区：
文献类型：
--
作者：
Cacoub, Patrice;Desbois, Anne Claire;Saadoun, David
背景和目的HCV的肝外表现是许多慢性感染患者发病率和死亡率的原因。新的，无干扰素的抗病毒治疗方案，目前有机会治疗所有HCV感染的患者，要求更好地了解治疗非丙型肝炎慢性infected individual.Methods的好处进行了系统评价。筛选了从Embase和Medline的目标数据库检索中识别的研究。评价了纳入出版物的方法学质量。进行了随机效应模型荟萃分析。证据的强度进行了评估，使用分级的建议评估，开发和Evaluation system.Results数据提取，共48个确定的研究。获得持续病毒学应答（SVR）与肝外死亡率降低相关（与无SVR相比，OR 0.44（95%CI 0.28 - 0.67））。SVR与冷球蛋白血症血管炎患者的完全缓解率较高（OR 20.76（6.73 - 64.05））和恶性B细胞淋巴组织增生性疾病患者的客观缓解率较高（OR 6.49（2.02 - 20.85））相关。实现SVR还与随访时胰岛素抵抗降低（OR 0.42（0.33至0.53））和对糖尿病发病率的显著保护作用（OR 0.34（0.21至0.56））相关。缺乏随机数据比较SVR与非SVR患者的相关肝外indications衰减these analysis.Conclusion抗病毒治疗可以减少肝外表现与HCV SVR时实现。需要更高质量的数据和更长随访期的报告，以彻底探索全面的HCV治疗策略。
Background and aims E xtrahepatic manifestations of HCV are responsible for morbidity and mortality in many chronically infected patients. New, interferonfree antiviral treatment regimens, which present the opportunity to treat all HCV-infected patients, call for a better understanding of the benefits of treating noncirrhotic chronically infected individuals.Methods A systematic review was conducted. Identified studies from targeted database searches on Embase and Medline were screened. The methodological quality of the included publications was evaluated. Random-effect model meta-analyses were performed. Strength of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation system.Results Data were extracted from a total of 48 identified studies. Achieving sustained virological response (SVR) was associated with reduced extrahepatic mortality (vs no SVR, OR 0.44 (95% CI 0.28 to 0.67)). SVR was associated with higher complete remissions in patients with cryoglobulinemia vasculitis (OR 20.76 (6.73 to 64.05)) and a higher objective response in those with malignant B-cell lymphoproliferative diseases (OR 6.49 (2.02 to 20.85)). Achieving SVR was also associated with reduced insulin resistance at follow-up (OR 0.42 (0.33 to 0.53)) and a significant protective effect on the incidence of diabetes (OR 0.34 (0.21 to 0.56)). Lack of randomised data comparing SVR versus non-SVR patients for the relevant extrahepatic indications attenuated these analyses.Conclusion A ntiviral therapy can reduce extrahepatic manifestations related to HCV when SVR is achieved. Higher quality data, and reporting over longer followup periods, will be required to thoroughly explore comprehensive HCV treatment strategies.