慢性丙型肝炎基因1型患者抗病毒治疗对丙型肝炎病毒核心抗原、肝脂肪变性和纤维化的影响  

Effects of antiviral therapy on HCV core antigen,hepatic steatosis,and fibrosis in patients with chronic hepatitis C genotype 1

作　　者：高兴娟[1] 程磊[1] 马秀清[1] 刘守珠[1] 王宝英[1] 刘海燕 才德吉 杨兴唐 Gao Xingjuan;Cheng Lei;Ma Xiuqing;Liu Shouzhu;Wang Baoying;Liu Haiyan;Cai Deji;Yang Xingtang(Department of Clinical Laboratory,Qinghai Red Cross Hospital,Qinghai Xining 810001,China;Department of Infectious Diseases,Qinghai Red Cross Hospital,Qinghai Xining 810001,China)

机构地区：[1]青海红十字医院检验科,青海西宁810001 [2]青海红十字医院感染科,青海西宁810001

出　　处：《新发传染病电子杂志》2024年第6期54-59,共6页Electronic Journal of Emerging Infectious Diseases

基　　金：青海省科技厅指导性计划项目(2022-ZJ-766)。

摘　　要：目的探讨慢性丙型肝炎(chronic hepatitis C,CHC)基因1型患者接受直接抗病毒药物(directacting antiviral agent,DAA)治疗期间,丙型肝炎病毒核心抗原(hepatitis C virus core antigen,HCV Ag)、受控衰减参数(controlled attenuation parameter,CAP)和基于4项因素的肝纤维化指数(fibrosis index based on 4 factors,FIB-4)变化及与治疗结果的关系。方法选取2020年3月至2021年5月在青海红十字医院接受DAA治疗的51例CHC患者作为研究对象。12周时持续病毒学应答(sustained virologic response at 12 weeks,SVR12)定义为治疗结束12周时HCV RNA检测量低于12U/ml。在基线、治疗第4周、治疗第8周、治疗结束和治疗结束后12周时评估HCV Ag和HCV RNA水平。HCV Ag使用化学发光微粒子免疫检测法测定。在基线、治疗结束和治疗结束后12周时评估CAP和FIB-4。结果共49例(96.08%)患者在基线时HCV Ag(>3fmol/L)和HCV RNA均呈阳性,其余2例仅HCV RNA呈阳性(分别为124U/ml、876U/ml)。基线HCV Ag和HCV RNA存在正相关性(r=0.505,P<0.001)。在DAA治疗期间,56.86%的患者在治疗第4周、84.31%的患者在治疗第8周和100%的患者在治疗结束时未检出HCV Ag。治疗结束后12周,共49例(96.08%)患者获得SVR12,且HCV Ag和HCV RNA检测一致性较高。治疗第4周和治疗第8周的HCV Ag和HCV RNA在预测SVR12时均具有较高的阳性预测值。与基线相比,治疗结束后12周时CAP值显著增加(P<0.05);治疗结束时和治疗结束后12周时FIB-4值均显著下降(P<0.05),且治疗结束后12周时FIB-4较治疗结束时进一步下降(P<0.05)。治疗结束后12周时FIB-4较基线值变化值与基线HCV Ag存在正相关关系(r=0.297,P<0.05)。结论DAA治疗可改善患者的肝纤维化,同时肝脂肪变性有增加趋势。在DAA治疗期间,使用HCV Ag可以监测HCV基因1型患者的治疗效果。Objective To determine the changes in hepatitis C virus core antigen(HCV Ag),controlled attenuation parameter(CAP),and fibrosis index based on 4 factors(FIB-4)during direct antiviral agent(DAA)treatment in patients with chronic hepatitis C(CHC)genotype 1,and their relationship with treatment outcomes.Method Fifty-one CHC patients who were treated with DAA in Our hospital from March 2020 to May 2021 were selected as the study objects.Sustained virological response(SVR)12 was defined as a sustained virological response of less than 12U/ml at the end of 12 weeks of treatment HCV Ag and HCV RNA levels were assessed at baseline,4 weeks of treatment,8 weeks of treatment,at the end of treatment,and 12 weeks after the end of treatment.HCV Ag was determined by chemiluminescent microparticle immunoassay.CAP and FIB-4 were assessed at baseline,at the end of treatment,and 12 weeks after treatment.Result A total of 49 patients(96.08%)were positive for both HCV Ag(>3fmol/L)and HCV RNA at baseline,and the remaining 2 patients were positive only for HCV RNA(124U/ml and 876U/ml,respectively).There was a significant positive correlation between HCV Ag and HCV RNA at baseline(P<0.001).During DAA treatment,56.86%of patients had no detectable HCV Ag at week 4,84.31%at week 8,and 100%at the end of treatment.Twelve weeks after the end of treatment,49 patients(96.08%)achieved SVR 12,and HCV Ag and HCV RNA tests were highly consistent.Both HCV Ag and HCV RNA at 4 and 8 weeks of treatment had higher positive predictive values in predicting SVR12.CAP values were significantly increased at 12 weeks after treatment compared with baseline(P<0.05).FIB-4 values at the end of treatment and 12 weeks after treatment were significantly decreased(P<0.05),and FIB-4 was further decreased at 12 weeks after treatment than at the end of treatment(P<0.05).Finally,there was a positive correlation between the change in FIB-4 from baseline and baseline HCV Ag at 12 weeks after treatment(P<0.05).Conclusion During DAA treatment,the use of HCV Ag can monitor th

关 键 词：慢性丙型肝炎 直接抗病毒药物 丙型肝炎病毒核心抗原 受控衰减参数 基于4项因素的肝纤维化指数 

分 类 号：R512.63[医药卫生—内科学]