索磷布韦/维帕他韦治疗静脉药瘾基因3型丙型病毒性肝炎持续病毒学应答的真实世界研究  

Sustained virological response of Sofosbuvir and Velpatasvir therapy in patients who inject drugs with genotype 3 hepatitis C virus infection:a real world study

作　　者：韦新焕[1] 杜晓菲[1] 柳雅立[1] 张晶[1] WEI Xin-huan;DU Xiao-fei;LIU Ya-li;ZHANG Jing(The Third Unit,Department of Hepatology,Beijing Youan Hospital,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京佑安医院肝病中心三科,北京100069

出　　处：《临床药物治疗杂志》2021年第12期16-21,共6页Clinical Medication Journal

基　　金：北京市丙型病毒性肝炎“发现-转诊-治疗”一体化综合管理模式研究(2020-1-3011)。

摘　　要：目的对静脉药瘾基因3型丙型病毒性肝炎(丙肝)患者的抗病毒治疗进行真实世界研究,探索其抗病毒治疗结束后12周持续病毒学应答(SVR12)的影响因素。方法回顾性收集2018年6月1日至2021年2月28日在首都医科大学附属北京佑安医院治疗的基因型为3型静脉药瘾人群(PWID)临床资料,对其治疗情况、SVR12率等进行分析。结果本研究初步纳入241例患者,经筛选后共77例患者纳入统计分析,基因3型总体SVR12率为76.62%,其中基因3a和3b型患者SVR12率分别为95.83%和67.92%。多因素分析提示,SVR12的独立影响因素为抗病毒治疗方案和基因型。在基因3b型患者中,与单用索磷布韦/维帕他韦(SOF/VEL)相比,使用SOF/VEL+利巴韦林(RBV)12周,可将SVR12率由38.89%提高至92.86%(P<0.01)。有4例3b型失代偿期肝硬化患者,因贫血等原因,无法耐受RBV,而采用SOF/VEL 24周方案,均获得SVR12。结论我国PWID抗病毒治疗率、依从性仍较低,有待加强患者教育及随访。基因3b型慢性丙肝患者应用SOF/VEL+RBV 12周方案与单用SOF/VEL相比,可提高SVR12率,对于不耐受RBV的3b型患者,SOF/VEL 24周方案可能是有效的替代方案之一。Objective This study aims to conduct a real-world study on the antiviral treatment of genotype 3 hepatitis C virus infection people who inject drugs(PWID),and explore the related factors of 12 week sustained virological response(SVR12).Methods PWID with genotypes 3 a and 3 b in Beijing Youan Hospital,Capital Medical University were collected retrospectively.The rates of treatment,compliance and SVR12 were analyzed,and the factors affecting SVR12 were explored.Results A total of 241 patients were included,and 77 patients were finally enrolled after screening.The overall SVR12 rate of genotype 3 patients was 76.62%,and were 95.83%and 67.92%in genotype 3 a and 3 b patients.Multivariate analysis showed that the independent factors affecting SVR12 were antiviral regimen and genotype.In patients with genotype 3 b,compared with Sofosbuvir/Velpatasvir(SOF/VEL)alone,twelve-week SOF/VEL+Ribavirin(RBV)regimen could significantly improve the SVR rate from 38.89%to 92.86%(P<0.01).There were 4 genotype 3 b patients with decompensated cirrhosis who could not tolerate RBV due to anemia and other reasons,all of which obtained SVR12 by using the 24 week SOF/VEL regimen.Conclusion The antiviral treatment rate and compliance in PWID are still low in China,and patient education and follow-up need to be strengthened.It’s necessary to combine RBV for genotype 3 b patients.For genotype 3 b patients who do not tolerate RBV,the 24 week SOF/VEL regimen may be one of the effective alternatives.

关 键 词：索磷布韦/维帕他韦 静脉药瘾人群 丙型肝炎病毒感染 持续病毒学应答 丙型肝炎病毒基因分型 

分 类 号：R978.7[医药卫生—药品] R512.63[医药卫生—药学]