Long-term hepatic function of patients with compensated cirrhosis following successful direct-acting antiviral treatment for hepatitis C virus infection
Long-term hepatic function of patients with compensated cirrhosis following successful direct-acting antiviral treatment for hepatitis C virus infection
复制标题
丙型肝炎病毒感染直接作用抗病毒治疗成功后代偿性肝硬化患者的长期肝功能
DOI：
10.1111/jgh.15703
复制
发表时间：
2022
影响因子：
4.1
通讯作者：
Eiichi Ogawa
中科院分区：
文献类型：
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作者：
Toyoshima S;Okayama Y;Eiichi Ogawa
背景和目的直接作用抗病毒药物 (DAA) 有助于改善所有慢性丙型肝炎患者的预后。本研究的目的是评估代偿性肝硬化患者使用 DAA 治愈丙型肝炎病毒 (HCV) 的长期肝脏益处。方法这项多中心队列研究由 2016 年 9 月之前开始无干扰素 DAA 治疗的连续代偿性肝硬化患者组成。治疗对长期肝功能的影响治疗结束后对功能进行至少 4 年的随访，并评估失代偿的进展情况。结果 394 名患者的数据可供研究。中位年龄为 70 岁，41% 的患者患有改良白蛋白-胆红素 (ALBI) 2b 级。在治疗结束后 1 年的短期随访中，FIB-4 指数和 ALBI 评分显着改善。 FIB‐4 < 3.25 (40%) 和 ALBI 1 级 (70%) 的达成率在第一年达到稳定水平；然而，第一年后血小板计数和甲胎蛋白水平有了显着的进一步改善。失代偿的年发生率为每 100 人年 1.30（95% 置信区间 0.83-2.02）。在多变量分析中，男性和基线时改良 ALBI 2b 级与失代偿相关。 结论 在接受 DAA 治疗的代偿性肝硬化患者的大型现实队列中，HCV 治愈后肝功能显着改善，尤其是在治疗结束后的第一年。肝硬化早期的治疗对于防止肝脏恶化至失代偿大有裨益。
Background and AimDirect‐acting antivirals (DAAs) have contributed to the improvement of outcomes for all patients with chronic hepatitis C. The aim of this study was to evaluate the long‐term hepatic benefits of hepatitis C virus (HCV) cure by DAAs in patients with compensated cirrhosis.MethodsThis multicenter cohort study consisted of consecutive patients with compensated cirrhosis who initiated interferon‐free DAA treatment before September 2016. The impact of treatment on long‐term hepatic function was followed for at least 4 years after the end of treatment, and the progression to decompensation was evaluated.ResultsThe data of 394 patients were available for study. The median age was 70, and 41% had modified albumin‐bilirubin (ALBI) grade 2b. During a short‐term follow‐up 1 year after the end of treatment, FIB‐4 index and ALBI score significantly improved. The achievement rates of FIB‐4 < 3.25 (40%) and ALBI grade 1 (70%) reached their plateau in the first year; however, there were significant further improvements in platelet count and α‐fetoprotein level after the first year. The annual incidence of decompensation was 1.30 (95% confidence interval 0.83–2.02) per 100 person‐years. In multivariable analysis, male sex and modified ALBI grade 2b at baseline were associated with decompensation.ConclusionsIn a large real‐world cohort of patients with compensated cirrhosis treated with a DAA, remarkable improvement in hepatic function was seen after HCV cure, especially during the first year after the end of treatment. Treatment in the early stage of cirrhosis would be of great benefit for preventing liver deterioration to decompensation.