索磷布韦/维帕他韦联合利巴韦林治疗慢性丙型肝炎患者疗效临床研究  

An observation of clinical efficacy of sofosbuvir/vipatavir and ribavirin combination in the treatment of patients with chronic hepatitis C

作　　者：樊秉栋 张国华 王君 Fan Bingdong;Zhang Guohua;Wang Jun(Intensive Care Unit,Provincial Infectious Disease Hospital,Xining 810000,Qinghai Province,China)

机构地区：[1]青海省传染病专科医院重症医学科,西宁市810000 [2]青海大学医学院附属医院肝胆科

出　　处：《实用肝脏病杂志》2021年第1期31-34,共4页Journal of Practical Hepatology

摘　　要：目的探讨应用索磷布韦/维帕他韦联合利巴韦林治疗慢性丙型肝炎(CHC)患者的疗效及血清细胞毒性T淋巴细胞相关抗原4(CTLA-4)、肿瘤坏死因子α诱导蛋白8样分子2(TIPE2)和白介素-12(IL-12)水平的变化。方法2018年5月~2019年5月我院肝病科就诊的105例CHC患者,采用随机数字表法将所选患者分为对照组51例和观察组54例,分别给予利巴韦林联合干扰素α-2b或者索磷布韦/维帕他韦联合利巴韦林治疗观察3个月。采用ELISA法[7]检测血清CTLA-4、TIPE2和IL-12水平。结果观察组快速病毒学应答(RVR)率为88.9%,显著高于对照组(43.1%,P<0.05),早期病毒学应答(EVR)率为90.7%,显著高于对照组(52.9%,P<0.05),治疗结束时应答率为96.3%,显著高于对照组(76.5%,P<0.05),持续病毒学应答(SVR)率为92.6%,显著高于对照组(60.8%,P<0.05);外周血白细胞水平为(5.2±2.0)×10^9/L,显著高于对照组【(3.4±1.8)×10^9/L,P<0.05】,红细胞水平为(4.9±0.5)×10^9/L,显著高于对照组【(4.6±0.7)×10^9/L,P<0.05】,血小板计数为(113.2±38.6)×10^9/L,显著高于对照组【(94.7±41.2)×10^9/L,P<0.05】;血清CTLA-4水平为(1.1±0.4)ng/mL,显著低于对照组【(1.6±0.7)ng/mL,P<0.05】,血清IL-12水平为(29.6±7.3)pg/mL,显著低于对照组【(41.5±11.7)pg/mL,P<0.05】,而血清TIPE2水平为(0.8±0.1)μg/L,显著高于对照组【(0.6±0.3)μg/L,P<0.05】;在治疗期间,观察组不良反应发生率为25.9%,显著低于对照组(94.1%,P<0.05)。结论应用索磷布韦/维帕他韦联合利巴韦林治疗CHC患者疗效好,除强大的抗病毒作用外,可能与该治疗能降低血清CTLA-4和IL-12水平,升高血清TIPE2水平有关。Objective To investigate the clinical efficacy of sofosbuvir/vipatavir and ribavirin combination in the treatment of patients with chronic hepatitis C(CHC).Methods 105 patients with CHC were recruited in the Department of Hepatology in our hospital between May 2018 and May 2019,and were randomly divided into control(n=51)and observation group(n=5),receiving ribavirin and interferon-α-2b,or sofosbuvir/vipatavir and ribavirin combination treatment for three months.Serum cytotoxic T lymphocyte-associated antigen 4(CTLA-4),tumor necrosis factor alpha-induced protein 8-like molecule 2(TIPE2),and interleukin-12(IL-12)levels were detected by ELISA.Results The rapid virologic response(RVR)rate in the observation group was 88.9%,significantly higher than 43.1%(P<0.05)in the control,the early virologic response rate(EVR)was 90.7%,significantly higher than 52.9%(P<0.05)in the control,the end treatment virological response(ETVR)rate was 96.3%,significantly higher than 76.5%(P<0.05)and sustained virologic response(SVR)rate was 92.6%,much higher than 60.8%(P<0.05)in the control;the white blood cell count was(5.2±2.0)×10^9/L,significantly higher than【(3.4±1.8)×10^9/L,P<0.05】,the red blood cell count was(4.9±0.5)×10^9/L,significantly higher than【(4.6±0.7)×10^9/L,P<0.05】,and the platelet count was(113.2±38.6)×10^9/L,significantly higher than【(94.7±41.2)×10^9/L,P<0.05】in the control;serum CTLA-4 level was(1.1±0.4)ng/mL,much lower than【(1.6±0.7)ng/mL,P<0.05】,serum IL-12 level was(29.6±7.3)pg/mL,much lower than【(41.5±11.7)pg/mL,P<0.05】,while serum TIPE2 level was(0.8±0.1)μg/L,significantly higher than【(0.6±0.3)μg/L,P<0.05】in the control group;during the treatment period,the incidence of side effects was 25.9%,significantly lower than 94.1%(P<0.05)in the control.Conclusion The application of sofosbuvir/vipatavivir and ribavirin combination in treatment of patients with CHC is efficacious,which might be related to the strong direct anti-viral effect and the reduction of serum CTLA-4 and IL-

关 键 词：慢性丙型肝炎 索磷布韦 维帕他韦 利巴韦林 细胞毒性T淋巴细胞相关抗原4 肿瘤坏死因子α诱导蛋白8样分子2 白介素-12 治疗 

分 类 号：R512.63[医药卫生—内科学]