减量索磷布韦联合全量达卡他韦治疗终末期肾病合并急性丙型肝炎患者临床疗效研究*

doi:10.3969/j.issn.1672-5069.2024.02.006

摘要/Abstract

摘要： 目的应用半量索磷布韦联合全量达卡他韦治疗长期血液透析的终末期肾病(ESRD)合并急性丙型肝炎(AHC)患者的临床效果。方法 2020年6月～2022年1月我院诊治的长期接受血液透析的ESRD合并AHC患者49例, 被随机分为观察组25例和对照组24例, 分别接受半量索磷布韦联合全量达卡他韦治疗或全量索磷布韦联合全量的达卡他韦治疗12周。使用全自动病毒载量分析系统检测血清HCV RNA载量。使用流式细胞仪检测外周血T淋巴细胞亚群。结果观察组获得早期病毒学应答、治疗结束病毒学应答、随访12周和24周持续病毒学应答率分别为72.0%、96.0%、88.0%和88.0%, 与对照组的70.8%、95.8%、87.5%和87.5%比, 差异无统计学意义(P>0.05);在治疗结束时, 观察组估算的肾小球滤过率(eGFR)为(12.5±1.0)ml/min·1.73m², 显著高于对照组【(9.0±1.0)ml/min·1.73m², P<0.05】, 而血清肌酐(sCr)水平为(448.5±11.7)μmol/L, 显著低于对照组【(477.4±12.6)μmol/L, P<0.05】;治疗前后两组外周血CD₄⁺细胞和CD₈⁺细胞百分比及CD₄⁺/CD₈⁺细胞比值均无显著性差异(P>0.05);观察组不良反应发生率为4.0%, 显著低于对照组的25.0%(P<0.05)。结论应用半量索磷布韦联合全量达卡他韦治疗长期血液透析的ESRD合并AHC患者不影响抗病毒疗效, 但可减轻肾功能损伤, 值得进一步研究, 优化治疗方案。

关键词: 丙型肝炎, 终末期肾病, 索磷布韦, 达卡他韦, 治疗

Abstract: Objective The aim of this study was to observe the virological response to half-dose of sofosbuvir and full-dose of daclatasvir therapy in patients with end-stage renal disease (ESRD) and acute hepatitis C (AHC). Methods 49 patients with ESRD and AHC who underwent long-term hemodialysis in our hospital were enrolled between June 2020 and January 2022, and were randomly divided into observation (n=25) and control (n=24) groups, receiving half-dose of sofosbuvir and full-dose of daclatasvir or full-dose of sofosbuvir and full-dose of daclatasvir antiviral therapy for 12 weeks. Serum HCV RNA load was detected by RT-PCR, and the peripheral blood T lymphocyte subsets were detected by flow cytometry. Results The rapid virological response, end-of-treatment virological response, 12-week sustained virological response (SVR12) and SVR24 in the observation group were 72.0%, 96.0%, 88.0% and 88.0%, not significantly different compared to 70.8%, 95.8%, 87.5% and 87.5% in the control group (P>0.05); at the end of antiviral treatment, the estimated glomerular filtration ratein the observation group was (12.5±1.0)ml/min·1.73m², much higher than , while serum creatinine level was (448.5±11.7)μmol/L, much lower than in the control; there were no significant differences as respect to the percentages of peripheral blood CD₄⁺cells and CD₈⁺cell as well as the CD₄⁺/CD₈⁺cell ratio between the two groups at the end of antiviral treatment or of the follow-up (P>0.05);the incidence of untoward effects in the observation group during the antiviral therapy was 4.0%, much lower than 25.0%(P<0.05)in the control group. Conclusion The modified half-dose of sofosbuvir and full-dose of daclatasvirin treating patients with ESRD and AHC is relatively efficacious, which might meet the request of antiviral therapy and the reduction of renal function injury, and needs multi-central verification.

Key words: Hepatitis C, End-stage renal disease, Sofosbuvir, Daclatasvir, Therapy

于欣欣, 付朝霞, 薛莉. 减量索磷布韦联合全量达卡他韦治疗终末期肾病合并急性丙型肝炎患者临床疗效研究^*[J]. 实用肝脏病杂志, 2024, 27(2): 181-184.

Yu Xinxin, FuZhaoxia, Xue Li. Similar virological response to half-dose of sofosbuvir and full-dose of daclatasvir therapy in patients with end-stage renal disease and acute hepatitis C[J]. Journal of Practical Hepatology, 2024, 27(2): 181-184.

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减量索磷布韦联合全量达卡他韦治疗终末期肾病合并急性丙型肝炎患者临床疗效研究^*

Similar virological response to half-dose of sofosbuvir and full-dose of daclatasvir therapy in patients with end-stage renal disease and acute hepatitis C

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