Cure or curd: Modification of lipid profiles and cardio-cerebrovascular events after hepatitis C virus eradication
Cure or curd: Modification of lipid profiles and cardio-cerebrovascular events after hepatitis C virus eradication
复制标题
DOI：
10.1002/kjm2.12275
复制
发表时间：
2020-07-09
影响因子：
3.3
通讯作者：
Yu, Ming-Lung
中科院分区：
文献类型：
--
作者：
Huang, Chung-Feng;Dai, Chia-Yen;Yu, Ming-Lung
丙型肝炎病毒（HCV）的根除使脂质谱恶化。虽然根除HCV可能降低血管事件的风险，但在某些患者中，恶化的脂质谱是否会增加心脑疾病的风险尚不清楚。在直接作用抗病毒药物（DAAs）治疗结束前、期间、期间和3个月后测量一系列脂质谱，并在治疗后第12周达到持续病毒学应答（SVR，无法检测到HCV RNA）的慢性丙型肝炎患者中每年测量一次。主要终点是事件的发生。共纳入617例患者，平均随访26.8个月（1 ~ 65个月）。总胆固醇和低密度脂蛋白胆固醇（LDL-C）水平在治疗后第4周至2年显著升高。Logistic回归分析显示，与胆固醇显著升高独立相关的因素包括年龄（比值比[OR]/95%可信区间[CI]:1.02/1.006-1.039，P= 0.007）和吸烟（OR/CI:3.21/1.14-9.02，P= 0.027）。在1376人年的随访期间，有5例患者出现心脑疾病。与无血管事件的患者相比，有血管事件的患者LDL-C激增的比例明显更高，达到40% （80% vs 19.9%，P= 0.001）。cox -回归分析显示，LDL-C激增bbb40 %是预测血管事件的唯一因素（HR/CI: 15.44/1.73-138.20，P= 0.014）。HCV根除后出现血脂异常，并与心脑血管疾病的发生风险相关。在svr后时代，除了肝脏相关并发症外，还应注意肝外后果。
Hepatitis C virus (HCV) eradication deteriorates lipid profiles. Although HCV eradication may reduce the risk of vascular events as a whole, whether deteriorated lipid profiles increases the risk of cardio-cerebral disease in certain patients is elusive. Serial lipid profiles were measured before, during, at and 3 months after the end of direct-acting antivirals (DAAs) therapy, and annually thereafter in chronic hepatitis C patients who achieved a sustained virological response (SVR, undetectable HCV RNA at posttreatment week 12). The primary end-point was the occurrence of the events. A total of 617 patients were included, with a mean follow-up period of 26.8 months (range: 1-65 months). The total cholesterol and low-density lipoprotein cholesterol (LDL-C) levels increased significantly from treatment week 4 to 2 years after treatment. Logistic regression analysis revealed that the factors independently associated with a significant cholesterol increase included age (odds ratio [OR]/95% confidence intervals [CIs]:1.02/1.006-1.039,P= .007) and smoking (OR/CI:3.21/1.14-9.02,P= .027). Five patients developed cardio-cerebral diseases during 1376 person-years follow-up period. Compared to patients without vascular events, a significantly higher proportion of those with vascular events experienced an LDL-C surge >40% (80% vs 19.9%,P= .001). Cox-regression analysis revealed that an LDL-C surge >40% was the only factor predictive of vascular events (HR/CI: 15.44/1.73-138.20,P= .014). Dyslipidemia occurred after HCV eradication, and it was associated with the risk of cardio-cerebrovascular diseases. Attention should also be paid to the extrahepatic consequence beyond liver-related complications in the post-SVR era.