慢性丙型肝炎应用直接抗病毒药物治疗后血尿酸水平的变化  

Changes of serum uric acid levels in patients with chronic hepatitis C after using direct antiv iral agents therapy

作　　者：梁静 刘芳[2] 张亚萍[1] 向慧玲 李春红[3] 韩涛[2,4,5] Liang Jing;Liu Fang;Zhang Yaping;Xiang Huiling;Li Chunhong;Han Tao(The Third Central Clinical College of Tianjin Medical University,Tianjin 300170,China;Department of Gastroenterology and Hepatology The Third Central Hospital of Tianjin,Tianjin 300170,China;Department of Nephrology The Third Central Hospital of Tianjin,Tianjin 300170,China;Tianjin Institute of Hepatobiliary Disease,Tianjin 300170,China;Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases,Tianjin 300170,China)

机构地区：[1]天津医科大学三中心临床学院,天津300170 [2]天津市第三中心医院消化肝病科,天津300170 [3]天津市第三中心医院肾内科,天津300170 [4]天津市肝胆疾病研究所,天津300170 [5]天津市重症疾病体外生命支持重点实验室,天津300170

出　　处：《中华肝脏病杂志》2022年第1期30-37,共8页Chinese Journal of Hepatology

摘　　要：目的慢性丙型肝炎抗病毒治疗有助于代谢状态的改善,但接受直接抗病毒药物(DAA)治疗后血清尿酸(SUA)水平的变化尚不明确。本研究旨在观察慢性丙型肝炎合并高尿酸血症的临床特点及DAA治疗后血尿酸水平的变化。方法用前瞻性的研究队列,探讨接受DAA治疗并获得持续病毒学应答的慢性丙型肝炎患者高尿酸血症的发生风险,观察DAA治疗后12周血尿酸水平的变化及相关的影响因素。组间比较应用校正的χ^(2)检验或Fisher精确检验、方差分析、Student's t检验或非参数Mann-Whitney U检验进行比较。应用通过重复测定及配对t检验比较治疗前后SUA、肝肾功能指标的变化。尿酸降低定义为治疗后12周SUA较基线下降。肾小球滤过率(eGFR)、天冬氨酸转氨酶/血小板比值、丙氨酸转氨酶及受控衰减指数变化比率定义为(基线-治疗后12周)/基线。采用二元Logistic回归分析比较与高尿酸血症及尿酸降低的风险因素及影响因素。结果纳入161例慢性丙型肝炎接受DAA治疗的患者,高尿酸血症患者占19.3%。eGFR<60 ml/(min·1.73 m2)及人体质量指数是慢性丙型肝炎患者发生高尿酸血症的独立风险因素(eGFR:OR=0.123,P=0.002;人体质量指数:OR=1.220,P=0.002)。治疗前、治疗结束及治疗后12周SUA水平明显变化(327.96比320.76比314.92,F=3.272,P=0.042),治疗后12周SUA、肝硬度、丙氨酸转氨酶及受控衰减指数较基线均有显著下降,P<0.05。治疗过程中eGFR较基线升高比率与受控衰减指数下降比率是SUA降低的影响因素(eGFR:OR=5124,P=0;受控衰减指数:OR=0.010,P=0.039)。结论慢性丙型肝炎发生高尿酸血症的风险因素为eGFR降低及人体质量指数,通过DAA治疗病毒清除后,血尿酸水平显著降低。Objective To observe the changes of serum uric acid levels and clinical characteristic in patients with chronic hepatitis C combined with hyperuricemia after direct antiviral agents(DAA)therapy.Methods A prospective cohort study was used to investigate the risk of hyperuricemia in patients with chronic hepatitis C who received DAA treatment to obtain sustained virological response.The changes and factors influencing serum uric acid levels after 12 weeks of DAA treatment were observed.Comparisons between groups were performed usings'test or Fisher's exact test,analysis of variance.Student's χ^(2) test,or the non-paramctric Mann-Whitney U test.Serum uric acid(SUA)changes,liver and kidney function indexes before and after treatment were compared by repeated measurement and paired t-test.Uric acid reduction was defined as a decrease in SUA from baseline at 12 weeks after treatment.Rates of change in eGFR,aspartate aminotransferase/platelet ratio,alanine aminotransferase and controlled attenuation parameter were defined from baseline(baseline to 12 weeks after treatment).Binary logistic regression analysis was used to compare the risk factors and factors influencing high and low uric acid level.Results 161 cases with chronic hepatitis C who received DAA treatment were included,of which 19.3% patients were hyperuricemic.eGFR<60 ml/(min•1.73 m^(2))and body mass index were independent risk factors for hyperuricemia in patients with chronic hepatitis C(eGFR:OR=0.123,P=0.002;body mass index:OR=1.220,P=0.002).SUA levels was changed significantly before treatment,at the end of treatment and at 12 weeks after treatment(327.96 vs.320.76 vs.314.92,F=3.272,P=0.042).At 12 weeks after treatment,SUA,liver stiffiiess,alanine aminotransferase and control attenuation parameters were all significantly lower than baseline(P<0.05).The rate of increase in eGFR from baseline and the rate of decrease in controlled attenuation parameter during treatment were the factors influencing SUA reduction(eGFR:OR=5124,P=0.000;controlled attenuation

关 键 词：慢性丙型肝炎 尿酸 高尿酸血症 直接抗病毒药物 

分 类 号：R512.63[医药卫生—内科学]