使用直接作用抗病毒药物 (DAAs) 根治慢性丙型肝炎后肝硬化患者的长期疗效。

IF 4.2 3区 医学 Q2 ONCOLOGY Journal of Hepatocellular Carcinoma Pub Date : 2024-10-30 eCollection Date: 2024-01-01 DOI:10.2147/JHC.S475810
Mohsen Salama, Nehad Darwesh, Maha Mohammad Elsabaawy, Eman Abdelsameea, Asmaa Gomaa, Aliaa Sabry
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引用次数: 0

摘要

目的:本研究旨在确定肝硬化患者在接受基于直接作用抗病毒药物(DAAs)的治疗方案后获得持续病毒学应答(SVR)的长期疗效:这项研究涉及193名HCV相关肝硬化患者,他们都曾完成DAAs治疗并获得SVR。分析了治疗结束后第一年和第三年随访的临床、实验室和放射学特征。在5年随访中确定了总生存期(OS)和肝功能失代偿或肝细胞癌(HCC)的发生率:结果:约68.4%的HCV相关性肝硬化患者为男性,平均年龄为(54.8 ± 7.7)岁。第一年和第三年的随访结果显示,白蛋白(P = 0.001)、肝酶(P = 0.001)、甲胎蛋白(AFP)(P < 0.001)、血小板计数(P = 0.001)、终末期肝病模型(MELD)评分(P = 0.001 和 0.01)、FIB4 和天冬氨酸氨基转移酶与血小板比值指数(APRI)评分(P < 0.001)均有显著改善。肝脏僵硬度(LS)也有明显改善(p = 0.001)。第5年的平均OS为58.3个月,分别有14.5%和17.6%的患者出现新发HCC和失代偿。发生HCC和肝功能失代偿的患者第5年随访的平均OS较短(P = 0.001)。甲胎蛋白和LS是HCC发生的预测因素:结论:尽管获得了 SVR,肝硬化患者仍需持续监测 HCC 和新出现的失代偿。
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Long-Term Outcomes of Patients with Liver Cirrhosis After Eradication of Chronic Hepatitis C with Direct-Acting Antiviral Drugs (DAAs).

Purpose: This research was designed to determine the long-term outcomes in patients with liver cirrhosis who achieved sustained virological response (SVR) after direct-acting anti-viral drugs (DAAs) based regimens.

Patients and methods: This study involved 193 patients with HCV-related cirrhosis who had previously completed DAAs regimens and accomplished SVR. Clinical, laboratory, and radiological features at the first and 3rd-year follow-up after the end of treatment were analyzed. Overall survival (OS) and incidence of liver decompensation or hepatocellular carcinoma (HCC) were determined at the 5-year follow-up.

Results: About 68.4% of our patients with HCV-related cirrhosis were males and their mean age was 54.8 ± 7.7 years. Follow-up at the first and the 3rd-year showed significant improvements in albumin (P = 0.001), liver enzymes (P = 0.001), alpha-fetoprotein (AFP) (P < 0.001), platelet count (P = 0.001), the model for end-stage liver disease (MELD) score (P = 0.001 and 0.01), FIB4 and Aspartate Aminotransferase-to-Platelet Ratio Index (APRI) scores (p < 0.001). The liver stiffness (LS) also significantly improved (p = 0.001). At the 5th year, the mean OS was 58.3 months, with 14.5% and 17.6% of patients developing de-novo HCC and decompensation, respectively. The mean OS at the 5th-year follow-up was shorter in patients who developed HCC and those with liver decompensation (p = 0.001). Alfa-fetoprotein and LS are predictive factors for HCC development.

Conclusion: Despite achieving SVR, continuous surveillance for HCC and new-onset decompensation is mandatory in patients with liver cirrhosis.

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CiteScore
0.50
自引率
2.40%
发文量
108
审稿时长
16 weeks
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