Dig Dis Sci:肥胖和糖尿病均可影响丙型肝炎患者直接抗病毒治疗后的效果

2021-07-30 MedSci原创 MedSci原创

丙型肝炎病毒 (HCV) 感染可导致患者出现肝纤维化、肝硬化和肝细胞癌 (HCC)。直接抗病毒药物 (DAA) 的使用使得根除慢性 HCV 感染成为可能。

      丙型肝炎病毒 (HCV) 感染可导致患者出现肝纤维化、肝硬化和肝细胞癌 (HCC)。直接抗病毒药物 (DAA) 的使用使得根除慢性 HCV 感染成为可能,有效的治疗效果称为持续病毒学应答 (SVR)。但是患者可能会出现不良反应,即使在 SVR 后,肝脏相关的发病率,包括肝硬化、门脉高压并发症有常有发生。在丙型肝炎 (HCV) 患者中,肥胖和/或糖尿病可能会增加肝脏相关结果的风险。因此,本项研究旨在确定糖尿病和/或肥胖是否与直接作用抗病毒 (DAA) 治疗的 HCV 患者的不良结果相关。

 

      研究人员为此对 2013 年至 2015 年间 33003 名感染 HCV且接受 DAA 治疗的退伍军人进行了一项回顾性研究。体重指数用于将患者分为体重不足 (< 18.5 kg/m2 )、体重正常 (18.5 至 < 25 kg/m2 ) )、超重(25 至 < 30 kg/m2)、肥胖 I(30 至 < 35 kg/m2)和肥胖 II-III(> 35 kg/m2 ))。糖尿病由 ICD-9/10 代码定义。从 DAA 治疗开始后 180 天到 2019 年 2 月 14 日对患者进行长期随访,以评估肝硬化、失代偿、肝细胞癌 (HCC) 和死亡的发展。多变量 Cox 比例风险回归模型用于确定糖尿病和/或肥胖与结果之间的关联。

 

 

      在平均 3 年的随访期间,10.1% 的患者出现死亡,5.0% 的患者新诊断为肝硬化,4.7% 的患者出现肝硬化失代偿,4.0% 的患者发展为 HCC。糖尿病与死亡率(AHR = 1.25,95% CI 1.10-1.42)、肝硬化(AHR = 1.31,95% CI 1.16-1.48)、失代偿(AHR = 1.74,95% CI 1.31-2.3)风险增加有关。 在没有基线肝硬化的患者中。与体重正常的人相比,肥胖者患肝硬化的风险更高,但超重和肥胖者的死亡率和 HCC 风险更低。

图:不同体重对于丙肝患者预后的影响

     本项研究证实接受DAA 治疗的HCV患者如果患有糖尿病会增加死亡率和肝脏相关事件的发生风险。尽管有患者可以获得SVR,但仍需对糖尿病患者保持警惕。

 

 

原始出处:

Jihane N. Benhammou. Et al. Nonalcoholic Fatty Liver Disease Risk Factors Affect Liver-Related Outcomes After Direct-Acting Antiviral Treatment for Hepatitis C. Digestive Diseases and Sciences. 2021.

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    2021-12-17 14775a26m11暂无昵称

    学习了

    0

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    2021-08-01 yahu
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    2021-07-30 misszhang

    谢谢MedSci提供最新的资讯

    0

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    2021-07-30 CHANGE

    疗效只是效果的众多方面之一,还要看对患者的获益,包括生活质量等因素共同决定效果的

    0

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