【文献解读】直接抗病毒治疗在丙型肝炎相关肝硬化患者中的临床结果观察
2017/10/18 创新医学网
文章来源:欧尔意 OAE 微信号
作者 :sofina
1原文出处
Berge E, Arencibia A, Otón E, Cejas L, Acosta S, Pérez F. Clinical outcomes of direct acting antiviral therapy in patients with compensated hepatitis c virus-related cirrhosis. Hepatoma Res 2017;3:209-14.
DOI: 10.20517/2394-5079.2017.28
2摘要
目的:本研究的主要目的是评估直接抗病毒治疗在一年随访后患有丙型肝炎相关性肝硬化的患者中的临床影响。方法:对2015年129例连续复发肝硬化患者进行了观察性回顾性研究,分析肝功能的改变,肝细胞癌的发生以及临床失代偿情况。结果:中位随访时间为16个月。 大多数患者为男性(73%),平均年龄为58.1岁,最常见的基因型为1b(52.2%)。 所有参与者在开始治疗时均为Child-Pugh A级,终末期肝病(MELD)评分为中位模型7。四例(4.4%)患有失代偿:三次腹水,一例急性慢性肝衰竭。 随访期间肝细胞癌的发生率为3.6%。 7名患者(7.8%)改善MELD评分超过1分,其中11例(12.2%)恶化了1分以上。治疗后,平均血小板计数(P < 0.001,95%置信区间:-26,360,-12,096)和平均白蛋白水平(P < 0.001,95%置信区间:-322,-130)都有显着改善。结论:直接抗病毒治疗在短期内与肝脏代偿失调或肝细胞癌的发展相比,与未治疗的代偿性肝硬化患者相比有所下降。 治疗前和治疗后血小板计数和白蛋白水平有改善,显示肝功能的可能改善。
Aim: The aim was to assess the clinical impact of direct-acting antiviral treatment in patients with compensated hepatitis C virus-related cirrhosis after one year of follow-up. Methods: An observational retrospective study was conducted on 129 consecutive patients with compensated cirrhosis treated in 2015, analyzing the evolution of liver function and the development of hepatocellular carcinoma and clinical decompensations. Results: The median follow-up time was 16 months. Most patients were males (73%), the mean age was 58.1 years and the most frequent genotype was 1b (52.2%). All participants were Child-Pugh A class at the start of the treatment and the median model for end-stage liver disease (MELD) score was 7. Four patients (4.4%) suffered a decompensation: three episodes of ascites and one acute on chronic liver failure. The incidence of de novo hepatocellular carcinoma during the follow-up was 3.6%. Seven patients (7.8%) improved MELD score more than one point and in 11 patients (12.2%) it worsened more than one point. There was a significant improvement in the mean platelets count [P < 0.001, 95% confidence interval (CI): -26,360, -12,096] and in the mean albumin levels (P < 0.001, 95% CI: -322, -130) after treatment. Conclusion: Direct-acting antiviral treatment is not associated in the short term with a decrease in the development of hepatic decompensation or hepatocellular carcinoma compared to what it was reported for untreated compensated cirrhotic patients. There is an improvement in pre and post-treatment platelet counts and albumin levels showing a probable improvement of the hepatic function.
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