直接抗病毒药物治疗丙型肝炎肝硬化患者血清血小板生成素和外周血血小板计数变化*

doi:10.3969/j.issn.1672-5069.2024.05.028

摘要/Abstract

摘要： 目的观察应用直接抗病毒药物(DAAs)治疗慢性丙型肝炎(CHC)和丙型肝炎肝硬化(LC)患者疗效及血清血小板生成素(TPO)和外周血血小板(PLT)计数的变化。方法 2019年2月～2022年6月我院诊治的CHC患者69例,丙型肝炎LC患者23例和LC并发血小板减少症(TP)患者68例,给予所有患者索磷布韦/维帕他韦片连续治疗12 w,随访24 w。采用ELISA法检测血清TPO水平。结果 LC并发TP组外周血白细胞计数、血小板计数和血清白蛋白水平分别为(5.0±1.3)×10⁹/L、(67.2±13.5)×10⁹/L和(32.9±1.4)g/L,显著低于CHB组【分别为(8.2±1.0)×10⁹/L、(182.8±32.7)×10⁹/L和(39.7±1.8)g/L,P<0.05】或LC组【分别为(7.5±1.2)×10⁹/L、(145.5±27.6)×10⁹/L和(35.7±1.5)g/L,P<0.05】,而血清总胆红素和INR分别为(29.5±6.3)μmol/L和(1.4±0.3),显著大于CHC组【分别为(17.1±5.9)μmol/L和(1.0±0.2),P<0.05】;LC并发TP组早期病毒学应答率、治疗结束病毒学应答率和持续病毒学应答率分别为60.3%、70.6%和66.2%,显著低于CHC组的87.0%、100%和97.1%(P<0.05) 或LC组的73.9%、82.6%和82.6%(P<0.05);在治疗结束时,LC和LC并发TP组血清TPO水平均显著升高【分别为(68.3±15.0)pg/ml对(42.5±17.6)pg/ml,P<0.05】和【(52.8±16.7)pg/ml对(37.2±13.5)pg/ml,P<0.05】,而外周血血小板计数也同步升高【分别为(184.9±33.8)×10⁹/L对(145.5±27.6)×10⁹/L,P<0.05】和【(101.0±26.3)×10⁹/L对(67.2±13.5)×10⁹/L,P<0.05】。结论应用DAAs治疗LC和LC并发TP患者在获得抗病毒疗效的同时,还能升高血小板计数,可能与改善了病情并升高血清TPO水平有关,值得进一步研究。

关键词: 丙型肝炎肝硬化, 血小板减少症, 直接抗病毒药物, 血小板生成素, 治疗

Abstract: Objective This clinical trial was conducted to investigate serum thrombopoietin (TPO) level and blood platelet count changes in patients with hepatitis C-induced liver cirrhosis (LC) receiving direct-acting antiviral agent (DAA) treatment. Method 69 patients with chronic hepatitis C (CHC), 23 patients with hepatitis C-induced LC and 68 patients with hepatitis C-induced LC and complicated thrombocytopenia (TP)were enrolled in this study between February 2019 and June 2022, and all were treated with sophobuvir/vipatavir for 12 weeks. After discontinuation of the regimen, all patients were followed-up for 24 weeks. Serum TPO levels were assayed by ELISA. Results The white blood cell count, platelet count and serum albumin level in patients with LC and TP were (5.0±1.3)×10⁹/L, (67.2±13.5)×10⁹/L and (32.9±1.4)g/L, all significantly lower than [(8.2±1.0)×10⁹/L, (182.8±32.7)×10⁹/L and (39.7±1.8)g/L, respectively, P<0.05] in patients with CHC or [(7.5±1.2)×10⁹/L, (145.5±27.6)×10⁹/L and (35.7±1.5)g/L, respectively P<0.05] in patients with LC, while total serum bilirubin level and international normalization rate of prothrombin time were (29.5±6.3)μmol/L and (1.4±0.3), both much greater than [(17.1±5.9)μmol/L and (1.0±0.2),P<0.05] in patients with CHC; the early virological response, end-of-treatment response and sustained virological response in patients with LC and TP were 60.3%, 70.6% and 66.2%, all significantly lower than 87.0%, 100% and 97.1%(P<0.05) in patients with CHC or 73.9%, 82.6% and 82.6%(P<0.05) in patients with LC; at the end of the antiviral regimen, serum TPO levels in patients with LC and LC with complicated TP increased greatly [(68.3±15.0)pg/ml vs. (42.5±17.6)pg/ml, P<0.05]and [(52.8±16.7)pg/mlvs. (37.2±13.5)pg/ml, P<0.05], and peripheral blood platelet counts increased simultaneously [(184.9±33.8)×10⁹/L vs. (145.5±27.6)×10⁹/L,P<0.05]and [(101.0±26.3)×10⁹/L vs. (67.2±13.5)×10⁹/L, respectively, P<0.05]. Conclusion The DAA treatment could improve thrombocytopenia besides antiviral efficacy, which might be related to the elevated serum TPO levels in patients with hepatitis C-induced LC, and warrants further clinical investigation.

Key words: Liver cirrhosis, Hepatitis C, Direct-acting antiviral agents, Thrombopoietin, Thrombocytopenia, Therapy

昝双江, 于恬, 戴静. 直接抗病毒药物治疗丙型肝炎肝硬化患者血清血小板生成素和外周血血小板计数变化^*[J]. 实用肝脏病杂志, 2024, 27(5): 757-760.

Zan Shuangjiang, Yu Tian, Dai Jing. Direct-acting antiviral agent treatment ameliorate thrombocytopenia in patients with hepatitis C-induced liver cirrhosis[J]. Journal of Practical Hepatology, 2024, 27(5): 757-760.

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直接抗病毒药物治疗丙型肝炎肝硬化患者血清血小板生成素和外周血血小板计数变化^*

Direct-acting antiviral agent treatment ameliorate thrombocytopenia in patients with hepatitis C-induced liver cirrhosis

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