索磷布韦/维帕他韦/伏西瑞韦再治疗DAAs治疗失败的不同基因型慢性丙型肝炎患者的疗效分析  

Efficacy of SOF/VEL/VOX retreatment in DAAs-failed chronic hepatitis C patientsswith different genotypes

作　　者：陈闪闪 严蓉[2] 周克[3] 刘凯芹 张一[5] 阳乔 胡爱荣 严冬[8] 吕芳芳[6] 石勇明 胡芳琴 马莉 荀运浩 黄何清 连江山[8] 刘涵云[12] 马春莲 金茜[14] 卢建平[15] 金洁[16] 杨杰 黄海军[2] Chen Shanshan;Yan Rong;Zhou Ke;Liu Kaiqin;Zhang Yi;Yang Qiao;Hu Airong;Yan Dong;Lyu Fangfang;Shi Yongming;Hu Fangqin;Ma Li;Xun Yunhao;Huang Heqing;Lian Jiangshan;Liu Hanyun;Ma Chunlian;Jin Qian;Lu Jianping;Jin Jie;Yang Jie;Huang Hajun(Department of Emergency Medicine,Zhejiang Provincial People's Hospital,Hangzhou 310014,China;Department of Infectious Diseases,Zhejiang Provincial People's Hospital,Hangzhou 310014,China;Department of Infectious Diseases,Ruian People's Hospital,Ruian 325200,Zhejiang Province,China;Department of Infectious Diseases,Weishi Central Hospital,Kaifeng 475500,Henan Province,China;Department of Infectious Diseases,the First Affliated Hospital of Nanchang Unversity,Nanchang 33000,China;Department of Infectious Diseases,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Hangzhou 310000,China;Department of Hepatology,Hwa Mei Hospital,University of Chinese Academy of Sciences,Ningbo 315010,Zhejiang Province,China;Department of Infectious Diseases,the First Afiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310003,China;Department of Infectious Diseases,Zhuji People's Hospital,Zhuji 311800,Zhejiang Province,China;Department of Infectious Diseases,the Affiliated Hospital of Shaoxing University,Shaoxing 312000,Zhejiang Province,China;Department of Hepatology of Integrated Traditional Chinese and Western Medicine,Xixi Hospital of Hangzhou,Hangzhou 310000,China;Department of Infectious Diseases,the Afiliated Hospital of Qingdao University,Qingdao 266000,Shandong province,China;Department of Infectious Diseases,the First People's Hospital of Wenling,Wenling 317500,Zhejang Province,China;Department of Infectious Diseases,Taizhou Central Municipal Hospital,Taizhou 318000,Zhejiang Province,China;Department of Infectious Diseases,Yuyao People's Hospital of Zhejiang Province,Yuyao 315400,Zhejiang Province,China;Department of Infectious Diseases,Affliated Hangzhou First People's Hospital,Zhejiang University School of Medicine,Hangzhou 310000,China;Department of Infectious Dise

机构地区：[1]浙江省人民医院急诊医学科,杭州310014 [2]浙江省人民医院感染病科,杭州310014 [3]浙江省瑞安市人民医院感染病科,瑞安325200 [4]河南省尉氏县中心医院感染病科,开封475500 [5]南昌大学第一附属医院感染病科,南昌330000 [6]浙江大学医学院附属邵逸夫医院感染病科,杭州310000 [7]中国科学院大学附属宁波华美医院肝病科,宁波315010 [8]浙江大学医学院附属第一医院感染病科,杭州310003 [9]浙江省诸暨市人民医院感染病科,诸暨311800 [10]绍兴文理学院附属医院感染病科,绍兴312000 [11]杭州市西溪医院中西医结合肝病科,杭州310000 [12]青岛大学附属医院感染病科,青岛266000 [13]浙江省温岭市第一人民医院感染病科,温岭317500 [14]台州市立医院感染病科,台州318000 [15]浙江省余姚市人民医院感染病科,余姚315400 [16]浙江大学医学院附属杭州市第一人民医院感染病科,杭州310000 [17]浙江大学医学院附属第四医院感染病科,义乌322000

出　　处：《中华临床感染病杂志》2023年第5期372-376,共5页Chinese Journal of Clinical Infectious Diseases

基　　金：国家自然科学基金面上项目(82272425);浙江省医药卫生科技计划项目(2019KY294)。

摘　　要：目的:评估索磷布韦/维帕他韦/伏西瑞韦(Sofosbuvir/Velpatasvir/Voxilaprevir,SOF/VEL/VOX)再治疗直接抗病毒药物(Direct acting antivirals,DAAs)治疗失败的不同基因型慢性丙型肝炎(Chronic hepatitis C,CHC)的有效性和安全性。方法:回顾性分析2022年1至10月16家医疗机构中DAAs治疗失败的21例CHC患者接受12周SOF/VEL/VOX抗病毒治疗的临床资料。分析患者基线、治疗4周、12周和治疗结束后12周的HCV RNA水平,以及基线和治疗结束后12周的血常规、肝肾功能等指标。收集患者治疗和随访期间的不良事件。采用SPSS 25.0对数据进行统计分析。结果:所有患者治疗4周、12周及治疗结束后12周均实现了病毒学应答。治疗结束后12周,丙氨酸转氨酶、天冬氨酸转氨酶和APRI均较治疗前下降(Z=-3.940、-3.680和-3.889,P值均<0.001),丙氨酸转氨酶复常率为95.2%(20/21)。2例(9.5%,2/21)患者出现胃肠道反应,包括腹痛、腹泻,恶心和呕吐。1例(4.8%,1/21)患者出现头痛,1例(4.8%,1/21)患者出现疲劳,未发生因不良反应引起的严重不良事件、死亡或中止治疗的情况。结论:SOF/VEL/VOX对CHC患者是一种有效且安全的再治疗方案,对于DAAs治疗失败的不同基因型患者具有良好的病毒学应答率,耐受性良好。

关 键 词：丙型肝炎 慢性 直接抗病毒药物 再治疗 索磷布韦/维帕他韦/伏西瑞韦 

分 类 号：R512.63[医药卫生—内科学]