基于索磷布韦的直接抗病毒药物治疗丙型肝炎肝硬化患者疗效评价  

Efficacy of antiviral therapy based on sorfosbuvir combination in the treatment of patients with hepatitis C-induced liver cirrhosis

作　　者：蔡峻岭 苏立 郝丽 赵敏 裴旭东 Cai Junling;Su Li;Hao Li(Department of Infectious Diseases,Central Hospital,Zhumadian 463000,Henan Province,China)

机构地区：[1]河南省驻马店市中心医院感染病科,463000 [2]郑州大学附属南阳市中心医院感染性疾病科

出　　处：《实用肝脏病杂志》2024年第3期406-409,共4页Journal of Practical Hepatology

基　　金：河南省科技厅科技发展计划项目(编号:222102310272)。

摘　　要：目的探讨基于索磷布韦(SOF)的直接抗病毒药物(DAAs)治疗代偿期丙型肝炎肝硬化(CHC-CLC)和失代偿期丙型肝炎肝硬化(CHC-DLC)患者的临床疗效。方法2019年7月~2022年12月我科诊治的CHC-CLC患者39例和CHC-DLC患者23例,分别接受SOF联合维帕他韦(VEL)或在此联合方案的基础上加用利巴韦林治疗12 w。采用实时荧光定量RT-PCR法检测血清HCV RNA载量,采用基因分型芯片检测HCV基因型,常规检测血常规和血生化指标,计算天冬氨酸氨基转移酶(AST)和血小板(PLT)比值指数(APRI)和肝纤维化4因子指数(FIB-4),使用Fibroscan行肝硬度检测(LSM)。结果到治疗结束时,CHC-DLC患者死亡2例(8.7%);在生存患者中,CHC-CLC组治疗早期病毒学应答率、治疗结束应答率、持续病毒学应答率(SVR24)和SVR48分别为92.3%、100.0%、100.0%和100.0%,显著优于CHC-DLC组(分别为80.9%、100.0%、76.2%和66.7%,P<0.05);治疗后,两组均获得病毒学应答,但CHC-CLC组血小板计数和白蛋白水平分别为(140.6±26.3)×10^(9)/L和(36.4±1.8)g/L,均显著高于CHC-DLC组【分别为(70.5±27.0)×10^(9)/L和(33.4±2.7)g/L,P<0.05】;CHC-CLC组APRI、FIB-4和LSM分别为(1.1±0.4)、(3.0±1.0)和(13.8±2.0)kPa,均显著低于CHC-DLC组【分别为(1.7±0.7)、(5.1±1.7)和(26.2±2.5)kPa,P<0.05】。结论基于SOF的DAAs治疗方案治疗CHC-CLC或CHC-DLC患者具有较为理想的病毒学应答率,肝功能指标得到改善,值得临床应用。Objective The aim of this study was to investigate clinical efficacy of antiviral therapy based on sorfosbuvir(SOF)combination in the treatment of patients with hepatitis C-induced liver cirrhosis(LC).Methods 39 patients with chronic hepatitis C-related compensated liver cirrhosis(CHC-CLC)and 23 patients with CHC-related decompensated liver cirrhosis(CHC-DLC)were encountered in our hospital between July 2019 and December 2022,and SOF and verapamil(VEL)combination was given in patients with CHC-CLC,and SOF and verapamil(VEL)combination plus ribavirin was given in patients with CHC-DLC for 12 weeks.Serum HCV RNA loads,biochemical index and routine blood cell counts were detected,and aspartate transaminase(AST)/platelet(PLT)ratio index(APRI)and fibrosis 4 score(FIB-4)were calculated.Liver stiffness measurement(LSM)was detected by Fibroscan.Results By end of treatment,two patients(8.7%)with CHC-DLC died;of survivals,early virologic response,end of treatment virologic response,sustained virologic response at 24 weeks(SVR 24)and SVR 48 in patients with CHC-CLC were 92.3%,100.0%,100.0%and 100.0%,all much superior to 80.9%,100.0%,76.2%and 66.7%(P<0.05)in patients with CHC-DLC;by end of antiviral treatment,peripheral blood platelet count and serum albumin level in patients with CHC-CLC were(140.6±26.3)×10^(9)/L and(36.4±1.8)g/L,both significantly higher than[(70.5±27.0)×10^(9)/L and(33.4±2.7)g/L,respectively,P<0.05]in patients with CHC-DLC;APRI,FIB-4 and LSM in patients with CHC-CLC were(1.1±0.4),(3.0±1.0)and(13.8±2.0)kPa,all significantly lower than[(1.7±0.7),(5.1±1.7)and(26.2±2.5)kPa,respectively,P<0.05]in patients with CHC-DLC.Conclusion DAAs therapy based on SOF has an satisfactory virological response in patients with CHC-CLC or CHC-DLC,with improved biochemical parameters,while the long-term efficacy needs further clinical observation.

关 键 词：肝硬化 丙型肝炎 直接抗病毒药物 索磷布韦 肝纤维化 治疗 

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