直接抗病毒药物治疗丙型肝炎肝硬化的疗效及影响因素分析  

Direct-acting antiviral agents for hepatitis C cirrhosis analysis of efficacy and influencing factors

作　　者：曹瑶 张元[3] 陈雪梅 杨兴祥[2] 唐荣珍[4] 耿晓霞[4] CAO Yao;ZHANG Yuan;CHEN Xuemei;YANG Xingxiang;TANG Rongzhen;GENG Xiaoxia(School of Medicine,University of Electronic Science and Technology of China,Chengdu 610054;Department of Infection,Sichuan Academy of Medical Sciences·Sichuan Provincial People′s Hospital;Medical Information Center,Sichuan Academy of Medical Sciences·Sichuan Provincial People′s Hospital;Department of Geriatric Infections,Sichuan Academy of Medical Sciences·Sichuan Provincial People′s Hospital,China)

机构地区：[1]电子科技大学医学院,四川成都610054 [2]四川省医学科学院·四川省人民医院感染科 [3]四川省医学科学院·四川省人民医院医学信息中心 [4]四川省医学科学院·四川省人民医院老年感染科

出　　处：《胃肠病学和肝病学杂志》2024年第9期1192-1201,共10页Chinese Journal of Gastroenterology and Hepatology

基　　金：2024年四川省科技厅川渝科技创新合作计划(2024YFHZ0068)。

摘　　要：目的探讨丙型肝炎肝硬化患者经直接抗病毒药物(direct-acting antiviral agents,DAAs)治疗后的疗效和相关影响因素。方法回顾性分析2017年9月至2022年4月就诊于四川省人民医院感染科的初治丙型肝炎肝硬化患者,分别经索磷布韦/维帕他韦±利巴韦林、来迪派韦/维帕他韦±利巴韦林、艾尔巴韦/格拉瑞韦等直接抗病毒药物治疗后的病毒学应答、血清生化学和肝脏纤维化程度的改善情况,并探讨其影响因素。结果纳入的54例丙型肝炎肝硬化患者中,代偿期肝硬化患者37例,失代偿期肝硬化患者17例。年龄(57.65±9.58)岁,其中24例(44.44%)为男性,患者基线平均HCV RNA载量为(5.60±0.90)lgIU/mL。经治疗后,90.74%的患者获得快速病毒学应答(rapid virologic response,RVR),治疗结束时病毒学应答率(end-of-treatment virologic response rate,ETVR)达100%。1例基因3b型患者在治疗结束后12周出现病毒复发,总人群中有98.15%的患者在治疗结束后12周获得持续病毒学应答(sustained virologic response 12 weeks,SVR12),其中失代偿期肝硬化患者100%获得SVR12。肝硬化总人群的血清ALT、AST、ALB、TBIL及FIB-4、APRI评分显著改善,PLT、Scr无明显变化。进一步亚组分析结果显示,年龄<60岁患者的ALB水平在治疗4周迅速出现显著改善,且持续至治疗结束12周,而年龄≥60岁患者ALB的显著改善延迟至治疗结束12周;HCV RNA<1×10^(6)IU/mL组患者的ALB在治疗4周及治疗结束12周持续出现显著改善,而HCV RNA≥1×10^(6)IU/mL组患者的ALB水平仅在治疗结束12周出现显著改善;基因1b型组治疗4周的FIB-4、APRI评分显著改善,治疗结束时及结束12周均出现ALB的显著改善,而基因非1b型组的FIB-4评分无显著改善,治疗结束12周才出现ALB的显著改善;代偿期肝硬化及失代偿期肝硬化患者在治疗初期至治疗结束12周的观察周期内,均出现血生化及无创肝纤维化指标的显著改善,两组的变化趋势�Objective To investigate the efficacy and related influencing factors of hepatitis C cirrhosis patients treated with direct-acting antiviral agents(DAAs).Methods To retrospectively analyze the improvement of virological response,serum biochemistry,and degree of hepatic fibrosis in patients with primary hepatitis C cirrhosis who attended the Department of Infection of the Sichuan Provincial People′s Hospital from Sep.2017 to Apr.2022 after treatment with direct antiviral drugs such as Sofosbuvir/Velpatasvir±Ribavirin,Laedipavir/Sofosbuvir±Ribavirin,and Elvitegravir/Gravitasvir,respectively,and to explore their influencing factors.Results Of the 54 patients with hepatitis C cirrhosis included,37 patients had compensated cirrhosis and 17 patients had decompensated cirrhosis.The mean age of the patients was(57.65±9.58)years old,of which 24 patients(44.44%)were male,and the mean HCV RNA load of the patients at baseline was(5.60±0.90)lgIU/ml.After treatment,90.74%of the patients achieved a rapid virologic response(RVR),with an end-of-treatment virologic response rate(ETVR)of 100%.One genotype 3b patient experienced viral relapse 12 weeks after the end of treatment,and 98.15%of the total population achieved sustained virologic response 12 weeks(SVR12)after the end of treatment,with 100%of the patients with decompensated cirrhosis achieving SVR12.Serum ALT,AST,ALB,TBIL,FIB-4 and APRI scores in the total cirrhotic population improved significantly,and there was no significant change in PLT and Scr.Further subgroup analyses showed that significant improvement in ALB levels occurred rapidly at 4 weeks of treatment and persisted until the end of 12 weeks of treatment in patients<60 years of age,whereas in patients≥60 years of age,the significant improvement in ALB was delayed until the end of 12 weeks of treatment.Patients in the HCV RNA<1×10^(6)IU/mL group continued to show significant improvement in ALB at 4 weeks of treatment and 12 weeks at the end of treatment,while patients in the HCV RNA≥1×10^(6)IU/mL grou

关 键 词：丙型肝炎 肝硬化 直接作用抗病毒药物 

分 类 号：R575[医药卫生—消化系统]