Long-term follow-up of diabetic and non-diabetic patients with chronic hepatitis C successfully treated with direct-acting antiviral agents
Long-term follow-up of diabetic and non-diabetic patients with chronic hepatitis C successfully treated with direct-acting antiviral agents
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DOI：
10.1111/liv.14676
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发表时间：
2020-11-23
影响因子：
6.7
通讯作者：
Saracco, Giorgio M.
中科院分区：
文献类型：
--
作者：
Ciancio, Alessia;Ribaldone, Davide G.;Saracco, Giorgio M.
背景和目的丙型肝炎病毒（HCV）的清除与糖尿病（DM）患者糖代谢控制的改善有关，但这种效果是否能长期维持并减少肝脏相关事件（LRE）仍有争议。方法893例慢性丙型肝炎患者中，15.7%为糖尿病患者（第1组），84.3%为非糖尿病患者（第2组）;在第1组中评估空腹血糖（FG）和糖化血红蛋白（HbA 1c）水平的变化，同时在整个队列中确定LRE的发生率。各组之间的差异进行了评估和独立的预测不利的临床outcome.Results后，平均随访44.5个月，FG和HbA 1c值显着降低，发现在第1组。第1组中5.7%的患者报告死亡，第2组中1.6%的患者报告死亡（P = 0.003），第2组中无肝细胞癌（HCC）生存率显著较低（P = 0.015），第1组中无LRE生存率显著较低（P = 0.0006）。校正基线变量后，肝硬化和白蛋白水平成为LRE的独立预测因子;低白蛋白水平、糖尿病和中心性肥胖与糖尿病患者的HCC风险相关，而胰岛素治疗是糖尿病患者的不利预测因素。结论DAA实现的SVR与糖尿病患者糖代谢控制的长期改善相关，但在糖尿病患者中，DM仍对肝脏产生有害影响。
Background and aims Clearance of hepatitis C virus (HCV) is associated with improved glycometabolic control in patients with diabetes mellitus (DM) but whether this effect is maintained over the long term with a reduction in liver-related events (LRE) is still debated. To address these issues, we conducted a long-term prospective study on diabetic and non-diabetic patients with chronic hepatitis C cured by direct antiviral agents (DAAs).Methods Among 893 recruited patients, 15.7% were diabetic (Group 1) and 84.3% non-diabetic (Group 2); changes in fasting glucose (FG) and glycated haemoglobin (HbA1c) levels were assessed in Group 1 while the incidence of LRE was established in the whole cohort. Differences between groups were evaluated and independent predictors of unfavourable clinical outcome were established.Results After a mean follow up of 44.5 months, a significant reduction in FG and HbA1c values was found in Group 1. Death was reported in 5.7% of patients in Group 1 vs 1.6% in Group 2 (P = .003), hepatocellular carcinoma (HCC)-free survival was significantly lower in Group 2 (P = .015) as well as LRE-free survival in Group 1 cirrhotic patients (P = .0006). After adjustment for baseline variables, cirrhosis and albumin levels emerged as independent predictors of LRE; low albumin levels, DM and central obesity were associated with HCC risk in cirrhotic patients while insulin therapy emerged as unfavourable predictor among diabetics.Conclusions SVR achieved by DAAs is associated with long-term improvement of glycometabolic control in diabetic patients, but among cirrhotics DM still exerts a detrimental effect on the liver.