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*

doi:10.3969/j.issn.1672-5069.2024.03.022

摘要/Abstract

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)×10⁹/L和(36.4±1.8)g/L,均显著高于CHC-DLC组【分别为(70.5±27.0)×10⁹/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。

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

Abstract: 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)×10⁹/L and (36.4±1.8)g/L, both significantly higher than [(70.5±27.0)×10⁹/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.

Key words: Liver cirrhosis, Hepatitis C, Direct acting antivirals, Sophobovir, Liver fibrosis, Therapy

蔡峻岭, 苏立, 郝丽, 赵敏, 裴旭东. 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^*[J]. 实用肝脏病杂志, 2024, 27(3): 406-409.

Cai Junling, Su Li, Hao Li, et al. Efficacy of antiviral therapy based on sorfosbuvir combination in the treatment of patients with hepatitis C-induced liver cirrhosis[J]. Journal of Practical Hepatology, 2024, 27(3): 406-409.

参考文献

[1] Le LN, O'Connor S, Tran TH, et al. High hepatitis C virus infection among female sex workers in Viet Nam: strong correlation with HIV and injection drug use. Western Pac Surveill Response J, 2019, 10(3): 9-18.
[2] Garcia-Crespo C, Francisco-Recuero I, Gallego I, et al. Hepatitis C virus fitness can influence the extent of infection-mediated epigenetic modifications in the host cells. Front Cell Infect Microbiol, 2023, 13: 1057082.
[3] Mei X, Zou J, Shi B, et al.High-resolution genomic profiling of a genotype 3b hepatitis C virus from a flare of an occult hepatitis patient with acute-on-chronic liver failure. Viruses, 2023, 15(3):232-236.
[4] 王瑞, 王学良, 李恒新, 等. 西安市吸毒人群 HCV 感染状况及影响因素分析. 中华疾病控制杂志, 2015, 19(12):1252-1254.
[5] Rungta S, Kumari S, Deep A, et al. APRI and FIB-4 performance to assess liver fibrosis against predefined Fibroscan values in chronic hepatitis C virus infection.J Family Med Prim Care, 2021, 10(11):4082-4088.
[6] You MW, Kim KW, Shim JJ, et al. Impact of liver-stiffness measurement on hepatocellular carcinoma development in chronic hepatitis C patients treated with direct-acting antivirals: A systematic review and time-to-event meta-analysis. J Gastroenterol Hepatol, 2021, 36(3):601-608.
[7] 中华医学会肝病学分会, 中华医学会感染病学分会. 丙型肝炎防治指南(2019 年版). 实用肝脏病杂志, 2020, 23(1): S33-52.
[8] Lourenco L, Kelly M, Tarasuk J, et al. The hepatitis C epidemic in Canada: An overview of recent trends in surveillance, injection drug use, harm reduction and treatment. Can Commun Dis Rep, 2021, 47(12): 561-570.
[9] 束青华, 张楠楠, 葛勇胜. 不同HCV基因型感染的慢性丙型肝炎和肝硬化患者对重组人干扰素α-2a治疗应答的影响. 实用肝脏病杂志, 2021, 24(6):899-902.
[10] Hu HH, Zhang C, Xie CB, et al. Prevalence and genotype distribution of hepatitis C virus from 1,668 individuals of Sichuan area in China. Clin Lab, 2021, 67(1):10.
[11] Zhou HJ, Cao J, Shi H, et al. Cost-effectiveness analysis of pan-genotypic sofosbuvir-based regimens for treatment of chronic hepatitis C genotype 1 infection in China. Front Public Health, 2021, 9:779215.
[12] Pan S, Feng K, Huang P, et al. Efficacy and safety of danoprevir plus sofosbuvir in GT 1, 2, 3, or 6 chronic hepatitis C patients with or without cirrhosis in China. Medicine (Baltimore), 2021, 100(24):e26312.
[13] Flamm S, Lawitz E, Borg B, et al. Efficacy and safety of sofosbuvir/velpatasvir plus ribavirin in patients with hepatitis C virus-related decompensated cirrhosis. Viruses, 2023, 15(10):2026.
[14] Tahata Y, Hikita H, Mochida S, et al. Sofosbuvir plus velpatasvir treatment for hepatitis C virus in patients with decompensated cirrhosis: a Japanese real-world multicenter study. J Gastroenterol, 2021, 56(1):67-77.
[15] Brzdk M, Zarbska-Michaluk D, Invernizzi F, et al. Decade of optimizing therapy with direct-acting antiviral drugs and the changing profile of patients with chronic hepatitis C. World J Gastroenterol, 2023, 29(6):949-966.
[16] Sohn W. Direct-acting antivirals trigger a favorable, sustained virological response in patients with chronic hepatitis C infections and hepatocellular carcinoma. Korean J Intern Med, 2021, 36(2):286-287.
[17] Xia X, Luo J, Bai J,et al. Epidemiology of hepatitis C virus infection among injection drug users in China: systematic review and meta-analysis. Public Health, 2008, 122(10):990-1003.
[18] 关富, 王胜炳, 张鸣青. 《2022年美国肝病学会实践指南:肝硬化失代偿期的症状管理和姑息性治疗》摘译.临床肝胆病杂志, 2022, 38(4):784-787.
[19] Duseja A, Singh SP, De A, et al. Indian National Association for Study of the Liver (INASL) Guidance Paper onnomenclature, diagnosis and treatment of nonalcoholic fatty liver disease (NAFLD). J Clin Exp Hepatol, 2023, 13(2):273-302.
[20] Mazzola G, Adamoli L, Calvaruso V, et al. Suboptimal performance of APRI and FIB-4 in ruling out significant fibrosis and confirming cirrhosis in HIV/HCV co-infected and HCV mono-infected patients. Infection, 2019, 47(3):409-415.
[21] Sripongpun P, Tangkijvanich P, Chotiyaputta W, et al. Evaluation of aspartate aminotransferase to platelet ratio index and fibrosis 4 scores for hepatic fibrosis assessment compared with transient elastography in chronic hepatitis C patients. JGH Open, 2019, 4(1):69-74.
[22] Abdelbary MS, Samir R, El-Nahaas SM, et al. Hepatitis Breactivation following eradication of HCV with direct-acting antiviral drugs (DAAs) in a cohort of patients from different institutions in Egypt. J Clin Exp Hepatol, 2022, 12(5):1276-1284.
[23] Li XH, Huang R, Yang M, et al. Gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid-enhanced magnetic resonance imaging for evaluating fibrosis regression in chronic hepatitis C patients after direct-acting antiviral. World J Gastroenterol, 2022, 28(20):2214-2226.
[24] Shin SK, Lee JW, Ra H, et al. Durability ofsustained virologic response and improvement of fibrosis markers after daclatasvir and asunaprevir treatment in genotype 1b hepatitis C virus-infected patients: a real life and multicenter study. J Korean Med Sci, 2019, 34(41):e264.

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

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