直接抗病毒药物治疗六例丙型肝炎病毒相关性皮肤损害患者的回顾性研究  

A retrospective study of 6 patients with hepatitis C virus associated cutaneous manifestations treated with direct-acting antivirals

作　　者：赵蕴玉 贺彩妮 高培根 刘莹[2] 姚雷清 高蓉[2] 刘佳姝 魏伏 李慎 朱龙飞 李政霄[2] 纪泛扑[1,5,6] Zhao Yunyu;He Caini;Gao Peigen;Liu Ying;Yao Leiqing;Gao Rong;Liu Jiashu;Wei Fu;Li Shen;Zhu Longfei;Li Zhengxiao;Ji Fanpu(Department of Infectious Diseases,The Second Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710004,China;Department of Dermatology,The Second Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710004,China;Department of Critical Care Medicine,Xi’an Fourth Hospital,Xi’an 710004,China;Institute of Virus,Shaanxi Province Center for Diseases Control and Prevention,Xi’an 710004,China;National-Local Joint Engineering Research Center of Biodiagnostics&Biotherapy,The Second Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710004,China;Shaanxi Provincial Clinical Research Center for Hepatic and Splenic Diseases,Xi’an 710004,China)

机构地区：[1]西安交通大学第二附属医院感染科,西安市710004 [2]西安交通大学第二附属医院皮肤科,西安市710004 [3]西安市第四医院重症医学科,西安市710004 [4]陕西省疾控中心病毒所,西安市710004 [5]西安交通大学第二附属医院生物诊断与治疗国家地方联合工程中心,西安市710004 [6]陕西省肝脾疾病临床医学研究中心,西安市710004

出　　处：《中华实验和临床感染病杂志（电子版）》2020年第6期507-512,共6页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：陕西省自然科学基础研究计划资助(No.2017JM8092);中央高校基本科研业务费(No.Nxzy012019107);西安交通大学医学部国家级后备人选菁英计划(No.305)。

摘　　要：目的探讨基于索磷布韦方案治疗丙型肝炎病毒(HCV)相关性皮肤损害的疗效和安全性。方法回顾性分析2016年2月至2019年9月西安交通大学第二附属医院收治的6例HCV相关性皮肤损害患者接受基于索磷布韦方案治疗的效果和安全性。评估其持续病毒学应答(SVR12)率,治疗过程和治疗结束后肝功能和皮损症状的变化以及安全性。结果6例患者年龄25~56岁;其中5例女性;2例肝硬化;3例基因型为HCV 1b,3例基因型为HCV 2a。皮损分别表现为阴囊湿疹、结节性痒疹、结节性红斑、扁平苔藓、干燥综合征和混和冷球蛋白血症相关皮损。2例患者病理确诊为HCV相关性皮损,4例患者临床诊断为HCV相关性皮损。患者接受索磷布韦/维帕他韦(3例)、索磷布韦/雷迪帕韦(2例)12周或索磷布韦/利巴韦林(1例)24周治疗。与基线水平相比,治疗结束或随访12周的丙氨酸氨基转移酶(ALT)显著降低、白蛋白(ALB)不变或升高,6例患者均获得SVR12且皮损均明显缓解。3例患者(阴囊湿疹、结节性痒疹、干燥综合征)皮损完全治愈,其他皮损包括结节性红斑、扁平苔藓、混和冷球蛋白血症相关皮损明显缓解,但需要接受免疫抑制剂和(或)细胞毒药物维持治疗。治疗期间未出现明显不良反应,随访期间皮损无复发。结论HCV可引起不同的肝外皮肤表现,基于索磷布韦的无干扰素方案治疗HCV相关皮肤损害有效且安全性良好。对于皮肤疾病经对症治疗后效果欠佳者,需要尽早行HCV筛查,确诊HCV感染后建议尽快给予抗病毒治疗。Objective To investigate the effect and tolerability of sofosbuvir-based regimens for hepatitis C virus(HCV)associated cutaneous manifestations.Methods The effect and tolerability of sofosbuvir-based direct-acting antivirals(DAAs)regimens for 6 patients with HCV infection and cutaneous manifestations in the Second Affiliated Hospital of Xi’an Jiaotong University were analyzed,retrospectively.The sustained virologic response at 12 weeks after end-of-treatment(SVR12),changes liver function,remission of skin lesions and safety during and after treatment were evaluated,respectively.Results The age of the 6 patients were 25-56 years old;including 5 female,2 cases with cirrhosis,3 cases with HCV genotype 1 b and 3 cases with HCV genotype 2 a.The cutaneous manifestations included eczema scrotum,prurigo nodosa,erythema nodosum,lichen planus,Sjogren’s syndrome and mixed cryoglobulinemia(MC)-associated rashes.Two patients were pathologically diagnosed as HCV-associated skin lesions,and 4 patients were clinically diagnosed.Patients received sofosbuvir/velpatasvir(3 cases)or sofosbuvir/ledipasvir(2 cases)for 12 weeks and sofosbuvir/ribavirin(1 case)for 24 weeks.There were significant reductions in serum alanine aminotransferase from baseline to the end-of-treatment and 12 weeks post-treatment,with slight increase or no change in serum albumin.All 6 patients achieved SVR12 and significant improvement of cutaneous manifestations.Three patients(eczema scrotum,prurigo nodosa and Sjogren’s syndrome)achieved completed remission of skin lesions,other skin lesions(erythema nodosum,lichen planus and MC-associated rashes)that significantly relieved,but required immunosuppressive and(or)cytotoxic to maintain therapy.No patient had experienced significant side-effects and recurrence of skin damage during the follow-up.Conclusions HCV could cause different extrahepatic skin manifestations,sofosbuvir-based regimens achieved high SVR12 rate,and alleviated the skin lesions.Screening for HCV should be performed in patients with cutaneo

关 键 词：肝炎病毒 丙型 肝外临床表现 皮肤 抗病毒药 索磷布韦 

分 类 号：R512.63[医药卫生—内科学]