PDF(Pubmed)
Abstract：
Hepatic osteodystrophy (HOD) is a common complication of chronic liver disease, including viral hepatitis. Hepatitis C virus (HCV) infection is associated with an increased risk of osteoporosis and bone mineral density (BMD) loss. Direct-acting antiviral (DAA) treatment is used to treat HCV infections; however, its effects on bone metabolism have not been reported. We compared the clinical data and bone metabolic markers at the start of DAA treatment and 1 year later in 78 patients. There were 41 female and 37 male patients. HCV was successfully treated with DAA in all patients. Bone metabolic markers included undercarboxylated osteocalcin (ucOC), 25(OH) vitamin D (VD), total type I procollagen N-propeptide (P1NP), tartrate-resistant acid phosphatase 5b (TRACP-5b), and BMD. BMD was measured in the lumbar spine (mean, L2-L4) and femoral neck using dual-energy X-ray absorptiometry. ucOC in males decreased at 1 year after treatment initiation but not in females. In males, ucOC changes were related to alterations in proteins induced by vitamin K absence-II (PIVKA-II), hemoglobin A1c, and TRACP-5b, which contributed to P1NP and lumbar BMD at the start of DAA. Changes in ucOC among women contributed to the changes in grip strength and TRACP-5b levels. DAA treatment improved ucOC, a useful bone metabolic marker, in HCV-infected male patients. Changes in ucOC contributed to changes in PIVKA-II that likely ameliorated the vitamin K deficiency. DAA treatment has been reported to improve various extrahepatic disorders and abnormal bone metabolism, especially in HOD.
摘要：
肝骨病（HOD）是慢性肝病的常见并发症，包括病毒性肝炎。丙型肝炎病毒（HCV）感染与骨质疏松症和骨矿物质密度（BMD）损失的风险增加有关。直接作用抗病毒（DAA）治疗用于治疗HCV感染;然而，其对骨代谢的影响尚未见报道。我们比较了78例患者在DAA治疗开始时和1年后的临床数据和骨代谢标志物。有41名女性和37名男性患者。所有患者均成功采用DAA治疗HCV。骨代谢标志物包括低羧化骨钙蛋白（ucOC），25（OH）维生素D（VD），总I型前胶原N-前肽（P1NP），抗酒石酸酸性磷酸酶5b（TRACP-5b），和BMD。在腰椎中测量BMD（平均值，L2-L4）和股骨颈使用双能X射线吸收法。治疗开始后1年，男性的ucOC下降，但女性没有下降。在男性中，ucOC变化与维生素K缺失-II（PIVKA-II）诱导的蛋白质改变有关，血红蛋白A1c，和TRACP-5b,在DAA开始时对P1NP和腰椎BMD有贡献。女性ucOC的变化导致了握力和TRACP-5b水平的变化。DAA治疗改善了ucOC，一种有用的骨代谢标记，在HCV感染的男性患者中。ucOC的变化导致PIVKA-II的变化，这可能改善了维生素K缺乏症。据报道，DAA治疗可改善各种肝外疾病和异常的骨代谢，尤其是在HOD。
