我国丙型肝炎肝硬化患者DAA治疗现状及短期预后的研究  

Study on the current status of Direct-acting antiviral Treatment in Chinese patients with HCV-related liver cirrhosis

作　　者：庄焱[1] 卢捷[1] 谢青[1] 林兰意 

机构地区：[1]上海交通大学医学院附属瑞金医院感染科,200025

出　　处：《肝脏》2020年第3期249-253,共5页Chinese Hepatology

基　　金：国家十三五科技重大专项“艾滋病和病毒性肝炎等重大传染病防治”(2017ZX10302201-004-005);上海市临床重点专科建设项目(感染病学);上海市卫生和计划生育委员会科研课题(20184Y0091);中国肝炎防治基金会王宝恩肝纤维化研究基金(CFHPC20171021)。

摘　　要：目的了解丙型肝炎肝硬化患者直接抗病毒药物(DAA)治疗现状、短期预后和影响因素。方法选取2015年1月至2019年11月期间于瑞金医院感染科诊治的丙型肝炎肝硬化患者,收集其数据,研究基线特征、DAA方案及疗效和预后的关系。结果共入组161例,DAA治疗者149例;代偿组122例,失代偿组27例;两组在年龄、性别、HCV基因型及干扰素治疗史等方面无显著性差别;两组疗效与安全性均良好,其中SVR12率(99.17%比96.25%,P=0.325)和SVR24率(96.64%比92.0%,P=0.614)均无明显差异;基线肝硬化失代偿期患者中发生肝病进展的比例明显高于代偿期患者(50%vs.13.75%,P=0.000);基线肝硬化失代偿是DAA治疗后短期预后的独立危险因素(HR 6.765,95%Cl:2.866~15.969,P=0.000)。结论基线肝硬化失代偿是DAA治疗后短期预后的独立预测因素。Objective To investigate the current treatment situation and explore the impact factors for short-term prognosis after direct-acting antiviral(DAA)therapy in Chinese patients with hepatitis C virus(HCV)-related liver cirrhosis.Methods Patients with HCV-related liver cirrhosis who visited the clinical center from Jan 2015 to Nov 2019 at the Department of Infectious Diseases,Ruijin Hospital,Shanghai Jiaotong University were enrolled.Clinical characteristics and DAA treatment status were collected according to current international practice guidelines.Impact factors for treatment responses and short-term prognosis after treatment were analyzed in the followed-up populations.Results A total of 161 patients with HCV-related liver cirrhosis were included,among which 149 received DAA therapies,122 compensated and 27 decompensated.Baseline charactersitics,including age,gender,HCV genotype and previous interferon(IFN)exposure history,were comparable between compensated and decompensated groups.Excellent treatment responses along with extremely low incidences of adverse events were achieved in both groups(both P<0.05).Rates of SVR12 and SVR24 were 99.17%vs.96.25%(P=0.325)and 96.64%vs.92.0%(P=0.614)in compensated and decompensated groups.Significant poorer prognosis was demonstrated in patients with decompensated cirrhosis when compared to compensated cirrhosis(50%vs.13.75%,P=0.000).The area under the receiver operating characteristic curve revealed decompensated cirrhosis before the initiation of treatment to be the only predictive factor for short-term prognosis after DAA treatment(HR 6.765,95%Cl:2.866-15.969,P=0.000).Conclusion Decompensated cirrhosis before the initiation of treatment was an independent impact factor for short-term prognosis after DAA treatment in HCV-related cirrhotic patients.

关 键 词：丙型肝炎 肝硬化 直接抗病毒药物 

分 类 号：R51[医药卫生—内科学]