3D方案治疗基因1b型低病毒载量慢性丙型肝炎患者应答疗效研究*

doi:10.3969/j.issn.1672-5069.2021.05.021

摘要/Abstract

摘要： 目的观察3D方案(帕里瑞韦/利托那韦/奥比他韦)联合达塞布韦治疗基因1b型低血清病毒载量的慢性丙型肝炎(CHC)患者的疗效及其血浆γ-干扰素(IFN-γ)和干扰素诱导蛋白10(IP-10)水平的变化。方法 2019年5月～2020年5月在我院接受治疗的基因1b型低血清病毒载量的CHC患者77例(初始治疗者62例,复治患者15例),接受3D方案联合达塞布韦治疗3个月,并随访3个月。采用ELISA法检测血浆IFN-γ和IP-10水平变化。评估早期病毒学应答(EVR)、治疗结束时病毒学应答(ETVR)和随访12周结束时持续病毒学应答(SVR12)。结果在接受3D方案抗病毒治疗后,初治患者EVR、ETVR和SVR12分别为51.6%、100.0%和100%,经治患者EVR、ETVR和SVR12分别为46.7%、100.0%和100%,两组差异无统计学意义(P>0.05);在治疗1 m、2 m、3 m和随访3 m,77例CHC患者血清HCV RNA转阴率分别为93.5%、98.7%、100.0%和100.0%;血清HCV RNA水平分别为(1.1±0.1)log₁₀IU/ml、(1.1±0.1)log₁₀IU/ml、(1.1±0.1)log₁₀IU/ml、(1.0±0.1)log₁₀IU/ml,显著低于治疗前;血清ALT水平分别为(16.8±4.1)U/L、(15.3±3.9)U/L、(11.1±3.2)U/L和(12.0±3.4)U/L,显著低于治疗前【(151.4±16.0)U/L,P<0.05】,血清AST水平分别为(20.4±4.7)U/L、(17.9±4.4)U/L、(18.0±5.1)U/L和(14.7±4.8)U/L,显著低于治疗前【(153.8±15.9),P<0.05】;血浆IFN-γ水平分别为(46.9±5.8)pg/ml、(50.2±6.3)pg/ml、(57.0±6.9)pg/ml和(51.3±4.6)pg/ml,显著高于治疗前,IP-10水平分别为(100.5±36.1)pg/ml、(72.1±22.8)pg/ml、(66.8±13.4)pg/ml和(68.7±12.5)pg/ml,显著低于治疗前。结论无论初治还是复治的基因1b型低血清病毒载量的CHC患者,采用3D方案治疗均可取得较好的近期疗效,安全性良好,需要继续随访观察长期疗效。

关键词: 慢性丙型肝炎, 帕里瑞韦/利托那韦/奥比他韦), 达塞布韦, 治疗

Abstract: Objective The aim of this study was to analyze the efficacy of 3D regimen (paritaprevir/ritonavir/ombitasvir combined with dasabuvir sodium) in the treatment of patients with chronic hepatitis C (CHC) with genotype 1b infection and low serum viral load. Methods A total of 77 patients (naïve patients in 62 and re-treated in 15) with CHC with gene 1b infection and low serum viral load (less than 7.0 log₁₀IU/ml) were recruited in our hospital between May 2019 and May 2020, and all received 3D regimen for 3 months and followed-up for 3 months. The early virological response (EVR), end treatment virologica response (ETVR) and sustained virologic response (SVR) were evaluated, and plasma interferon-γ (IFN-γ) and interferon-inducible protein 10 (IP-10) levels were detected by ELISA. Results The EVR, ETVR and SVR12 in naïve patients were 51.6%, 100.0% and 100%, and were 46.7%, 100.0% and 100% in re-treated patients (P>0.05); serum HCV RNA negativities in the 77 patients with CHC at the end of one month, two months, three months and three months after treatment were 93.5%, 98.7%, 100.0% and 100.0%, and serum HCV RNA loads were (1.1±0.1)log₁₀IU/ml,(1.1±0.1)log₁₀IU/ml,(1.1±0.1)log₁₀IU/ml and (1.0±0.1)log₁₀IU/ml, respectively, significantly lower than at presentation; serum alanine aminotrasaminase levels were (16.8±4.1)U/L, (15.3±3.9)U/L, (11.1±3.2)U/L and (12.0±3.4)U/L, all significantly lower than , and serum aspartate aminotransferase levels were(20.4±4.7)U/L,(17.9±4.4)U/L,(18.0±5.1)U/L and (14.7±4.8)U/L, all significantly lower than at presentation; plasma IFN-γ levels were (46.9±5.8)pg/ml, (50.2±6.3)pg/ml, (57.0±6.9)pg/ml and (51.3±4.6)pg/ml, significantly higher than , while plasma IP-10 level were (100.5±36.1)pg/ml, (72.1±22.8)pg/ml, (66.8±13.4)pg/ml and (68.7±12.5)pg/ml, significantly lower than at presentation. Conclusion 3D regimen could achieve a better short-term efficacy in the treatment of no matter naïve or re-treated patients with CHC with genetype 1b infection with low serum viral loads, and warrants further and long-term observation.

Key words: Hepatitis C, Paritaprevir/Ritonavir/Ombitasvir, Dasabuvir s, Therapy

韩宏艳, 潘娟, 蒋文平, 张敏. 3D方案治疗基因1b型低病毒载量慢性丙型肝炎患者应答疗效研究^*[J]. 实用肝脏病杂志, 2021, 24(5): 689-692.

Han Hongyan, Pan Juan, Jiang Wenping, et al. Efficacy of 3D regimen in the treatment of patients with chronic hepatitis C with genotype 1b infection[J]. Journal of Practical Hepatology, 2021, 24(5): 689-692.

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3D方案治疗基因1b型低病毒载量慢性丙型肝炎患者应答疗效研究^*

Efficacy of 3D regimen in the treatment of patients with chronic hepatitis C with genotype 1b infection

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