丙通沙联合利巴韦林片治疗丙型肝炎肝硬化失代偿期的效果  

Effect of epclusa combined with ribavirin tablets in the treatment of decompensated hepatitis C cirrhosis

作　　者：尚宁[1] 安萍[1] 卞丽[1] SHANG Ning;AN Ping;BIAN Li(Shenyang Sixth People’s Hospital,Shenyang 110006,China)

机构地区：[1]沈阳市第六人民医院,110006

出　　处：《中国实用医药》2021年第23期130-132,共3页China Practical Medicine

摘　　要：目的观察对丙型肝炎肝硬化失代偿期患者应用索磷布韦维帕他韦片(商品名:丙通沙)联合利巴韦林片治疗的效果。方法46例丙型肝炎肝硬化失代偿期患者,进行常规的保肝、利尿以及纠正低蛋白血症等对症治疗。比较丙型肝炎病毒(HCV)Ⅰ型、Ⅱ型患者治疗前后生化指标、肝功能指标、血清基因型抗病毒治疗的应答情况,记录不良反应发生情况。结果治疗后,患者丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素(TBIL)、Child-Pugh评分均有所改善,且HCVⅡ型患者ALT(35.66±29.52)U/L、AST(31.54±10.11)U/L、TBIL(22.82±4.62)μmol/L、Child-Pugh评分(6.11±1.26)分均低于HCVⅠ型患者的(56.15±34.21)U/L、(55.36±34.36)U/L、(38.96±11.34)μmol/L、(8.12±1.30)分,差异均具有统计学意义(P<0.05)。HCVⅡ型患者中早期病毒学应答率、早期生化学应答率、疗程结束时血清ALT复常率、疗程结束时HCV-RNA转阴率均高于HCVI型患者,差异均具有统计学意义(χ^(2)=4.394、4.394、4.785、3.948,P<0.05)。在46例患者中,有8例患者出现血红蛋白水平下降的现象,通过减少利巴韦林剂量,患者均缓解了症状;有4例患者出现胃肠道反应现象,予以对症治疗后,均好转;有2例患者出现头痛、头晕、恶心等症状,通过减少利巴韦林剂量,患者均缓解了症状。所有患者均顺利完成治疗。结论对丙型肝炎肝硬化失代偿期患者应用丙通沙联合利巴韦林片治疗有显著效果,且安全可靠。Objective To observe the effect of sofosbuvir and velpatasvir tablets(trade name:epclusa)combined with ribavirin tablets in the treatment of decompensated hepatitis C cirrhosis.Methods A total of 46 patients with decompensated hepatitis C cirrhosis all received routine symptomatic treatment such as liver protection,diuresis,and correction of hypoproteinemia.The biochemical indexes,liver function indexes and response of serotype antiviral therapy of patients with typeⅠand typeⅡhepatitis C virus(HCV)before and after treatment were compared,and the occurrence of adverse reactions was recorded.Results After treatment,the alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL)and Child-Pugh score of patients were improved;the ALT(35.66±29.52)U/L,AST(31.54±10.11)U/L,TBIL(22.82±4.62)μmol/L and Child-Pugh score(6.11±1.26)points of patients with typeⅡHCV were lower than(56.15±34.21)U/L,(55.36±34.36)U/L,(38.96±11.34)μmol/L and(8.12±1.30)points of patients with typeⅠHCV;all the difference was statistically significant(P<0.05).The early virological response rate,early biochemical response rate,serum ALT normalization rate at the end of the treatment,and negative-conversion rate of HCV-RNA at the end of the treatment in of patients with typeⅡHCV were all higher than those of patients with typeⅠHCV,and the differences were statistically significant(χ^(2)=4.394,4.394,4.785,3.948;P<0.05).Among the 46 patients,8 patients had decreased hemoglobin level,and the symptoms were relieved after reducing the dose of ribavirin.There were 4 cases of gastrointestinal reactions,which were improved after symptomatic treatment.There were 2 patients with headache,dizziness,nausea and other symptoms,and the symptoms were relieved after reducing the dose of ribavirin.All patients completed the treatment successfully.Conclusion Combination of Epclusa and ribavirin has significant effect on patients with decompensated hepatitis C cirrhosis,and it is safe and reliable.

关 键 词：丙型肝炎 肝硬化失代偿期 丙通沙 利巴韦林 

分 类 号：R512.63[医药卫生—内科学] R575.2[医药卫生—临床医学]