Ongoing liver inflammation in patients with chronic hepatitis C and sustained virological response
Ongoing liver inflammation in patients with chronic hepatitis C and sustained virological response
复制标题
慢性丙型肝炎患者持续的肝脏炎症和持续的病毒学反应
作者：
C. Welsch;Mira Efinger;M. von Wagner;E. Herrmann;S. Zeuzem;T. Welzel;C. Lange
背景新型直接抗病毒 DAA 联合疗法极大地改善了慢性 HCV 感染患者的持续病毒学应答 (SVR) 率。 SVR 通常伴随着肝酶的正常化，然而，尽管 HCV 被根除，肝脏炎症（即转氨酶水平持续升高）仍可能持续存在。目的：调查两个大型患者队列 SVR 后持续肝脏炎症的患病率和危险因素。方法 这项事后分析基于前瞻性收集的人口统计和临床数据，这些数据来自 PRAMA 试验 (n = 341) 中的 834 名接受基于 PegIFN 或 DAA 的治疗方案的 HCV 治疗后出现 SVR 的患者 (n = 341) 或在我们的门诊诊所接受治疗的患者 (n = 493)。结果我们观察到 SVR 后炎症的患病率出人意料地高，包括接受新型无干扰素 DAA 疗法的患者。多达 10% 的患者转氨酶水平持续升高，另外 25% 的患者转氨酶活性高于所谓的健康范围。几个基线因素与 SVR 后转氨酶升高独立相关。其中，特别是男性，晚期肝病和肝脂肪变性标志物强烈预测 ALT 持续升高。基于干扰素的抗病毒治疗的使用与 SVR 后炎症独立相关，进一步支持无干扰素联合治疗方案的总体益处。结论 这是第一项针对大型患者队列的综合研究，调查了根除 HCV 后持续性肝脏炎症的患病率和危险因素。我们的数据显示，尽管 HCV 已被根除，但仍有很高比例的患者持续存在肝脏炎症，这对大约三分之一的 SVR 患者的治疗具有潜在影响。
Background Novel direct-acting antiviral DAA combination therapies tremendously improved sustained virologic response (SVR) rates in patients with chronic HCV infection. SVR is typically accompanied by normalization of liver enzymes, however, hepatic inflammation, i.e. persistently elevated aminotransferase levels may persist despite HCV eradication. Aim: To investigate prevalence and risk factors for ongoing hepatic inflammation after SVR in two large patient cohorts. Methods This post-hoc analysis was based on prospectively collected demographic and clinical data from 834 patients with SVR after HCV treatment with either PegIFN- or DAA-based treatment regimens from the PRAMA trial (n = 341) or patients treated at our outpatient clinic (n = 493). Results We observed an unexpected high prevalence of post-SVR inflammation, including patients who received novel IFN-free DAA-based therapies. Up to 10% of patients had ongoing elevation of aminotransferase levels and another 25% showed aminotransferase activity above the so-called healthy range. Several baseline factors were independently associated with post-SVR aminotransferase elevation. Among those, particularly male gender, advanced liver disease and markers for liver steatosis were strongly predictive for persistent ALT elevation. The use of IFN-based antiviral treatment was independently correlated with post-SVR inflammation, further supporting the overall benefit of IFN-free combination regimens. Conclusion This is the first comprehensive study on a large patient cohort investigating the prevalence and risk factors for ongoing liver inflammation after eradication of HCV. Our data show a high proportion of patients with ongoing hepatic inflammation despite HCV eradication with potential implications for the management of approximately one third of all patients upon SVR.
影响因子：
11.1
作者：
Lange CM;Jacobson IM;Rice CM;Zeuzem S
通讯作者：
Zeuzem S