索磷布韦联合维帕他韦治疗丙型肝炎肝硬化患者临床疗效和门脉超声检查指标变化研究*

doi:10.3969/j.issn.1672-5069.2025.04.027

摘要/Abstract

摘要： 目的观察索磷布韦联合维帕他韦治疗丙型肝炎肝硬化患者的临床疗效及其超声检查的门脉指标的变化。方法 2021年6月～2024年6月我院收治的54例丙型肝炎肝硬化(代偿期31例,失代偿期23例)患者,给予所有患者索磷布韦和维帕他韦治疗,另给予失代偿期患者利巴韦林联合治疗,均持续治疗12周。采用荧光定量PCR法检测血清HCV RNA载量,采用放射免疫分析法检测血清透明质酸(HA)、Ⅲ型前胶原(PCⅢ)、Ⅳ型胶原(Ⅳ-C)和层粘连蛋白(LN),常规行肝脏硬度检测(LSM)及门静脉内径(PVD)和脾脏厚度(ST)检测。结果本组丙型肝炎肝硬化患者经索磷布韦和维帕他韦或联合巴韦林治疗,获得持续性病毒学应答率为94.4%,除1例基因1型和2例基因3型感染者外,均获得SVR;在治疗1个月、3个月和停药后3个月,代偿期肝硬化患者病毒学应答(VR)均为100.0%,而失代偿期肝硬化患者则分别为78.3%、82.6%和87.0%;治疗后,代偿期患者血清HA、PCⅢ和Ⅳ-C水平分别为(92.6±21.4)μg/L、(127.2±28.4)μg/L和(105.6±26.8)μg/L,均显著低于失代偿期【分别为(139.4±35.8)μg/L、(197.6±34.8)μg/L和(166.2±32.9)μg/L,P<0.05】;代偿期患者LSM和PVD分别为(18.2±2.1) kPa和(13.4±1.3)mm,均显著低于失代偿期患者【分别为(20.7±2.3)kPa和(15.8±1.1)mm,P<0.05】。结论应用索磷布韦和维帕他韦联合或不联合利巴韦林治疗丙型肝炎肝硬化患者疗效好,安全。

关键词: 肝硬化, 丙型肝炎, 索磷布韦, 维帕他韦, 治疗

Abstract: Objective The aim of this study was to investigate the clinical efficacy of sofosbuvir and velpatasvir combination regimen in the treatment of patients with hepatitis C-induced liver cirrhosisand its influence on ultrasonic indexes of portal vain. Methods 54 patients with hepatitis C-induced liver cirrhosis, including compensated in 31 cases and decompensated in 23 cases, were enrolled in our hospital between June 2021 and June 2024, patients with compensated liver cirrhosis received sofosbuvir and velpatasvir combination, and those with decompensated liver cirrhosis received ribavirin at base of sofosbuvir and velpatasvir combination. Antiviral therapy lasted for 12 weeks. Serum HCV RNA loads were detected by fluorescenct quantitative RT-PCR, and serum hyaluronic acid (HA), type III procollagen (PCIII), type IV collagen (IV-C) and laminin (LN) levels were assayed immunoradiometric assay. Liver stiffness measurement (LSM), portal vein diameter (PVD) and spleen thickness (ST) were measured by Fibrotouch or ultrasonic diagnostic instrument. Results The sustained viral response (SVR) rate in our series was 94.4%, all but one with HCV genotype 1 and two with HCV genotype 3 responded completely to the antiviral therapy; virological response rate in patients with compensated cirrhosis at month one, month three and three months after discontinuation of antiviral therapy were all 100.0%, while in those with decompensated cirrhosis were 78.3%, 82.6% and 87.0%, respectively; after treatment, serum HA, PCⅢ and Ⅳ-C levels in patients with compensated cirrhosis were (92.6±21.4)μg/L, (127.2±28.4)μg/Land (105.6±26.8)μg/L, all significantly lower than [(139.4±35.8)μg/L, (197.6±34.8)μg/Land (166.2±32.9)μg/L, respectively, P<0.05] in those with decompensated cirrhosis; LSM and PVD were (18.2±2.1) kPa and (13.4±1.3)mm, both much less than [(20.7±2.3)kPa and (15.8±1.1)mm, respectively, P<0.05] in those with decompensated cirrhosis. Conclusion Sofosbuvir and velpatasvir combination with or without ribavirin in the treatment of patients with hepatitis C-induced liver cirrhosis is efficacious, which warrants further clinical observation.

Key words: Liver cirrhosis, Hepatitis C, Sofosbuvir, Velpatasvir, Therapy

施海群, 钱杰, 沈国倩, 赵萌. 索磷布韦联合维帕他韦治疗丙型肝炎肝硬化患者临床疗效和门脉超声检查指标变化研究^*[J]. 实用肝脏病杂志, 2025, 28(4): 585-588.

Shi Haiqun, Qian Jie, Shen Guoqian, et al. Satisfactory response to sofosbuvir and velpatasvir combination regimen in patients with hepatitis C-induced liver cirrhosis[J]. Journal of Practical Hepatology, 2025, 28(4): 585-588.

参考文献

[1] Huang DQ, Terrault NA, Tacke F,et al. Global epidemiology of cirrhosis-aetiology, trends and predictions. Nat Rev Gastroenterol Hepatol, 2023,20(6):388-398.
[2] Rashed YK, Khalaf FA, Kotb SE. Thyroid disturbances in children treated with combined pegylated interferon-alpha and ribavirin for chronic hepatitis C. Clin Exp Pediatr, 2020,63(2):52-55.
[3] Pluta M, Pokorska-piewak M, Aniszewska M, et al. Pegylated interferon and ribavirin gone but not forgotten in the era of direct-acting antivirals. Minerva Pediatr (Torino), 2022,74(1):23-30.
[4] 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. 实用肝脏病杂志,2024,27(5):757-760.
[5] 蔡峻岭,苏立,郝丽,等. 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. 实用肝脏病杂志,2024,27(3):406-409.
[6] 丁闪闪,丁凯,姜宁. 索磷布韦联合维帕他韦治疗丙型肝炎肝硬化患者疗效及安全性分析. 实用肝脏病杂志,2023,26(4):536-539.
[7] 中华人民共和国国家卫生和计划生育委员会. WS213-2018丙型肝炎诊断. 临床肝胆病杂志,2018,34(8):1619-1621.
[8] 中华医学会肝病学分会. 肝硬化诊治指南. 中华肝脏病杂志,2019,27(11):846-865.
[9] 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(2022年版).中华肝脏病杂志,2022,30(12):1332-1348.
[10] St Louis J, Baumgartner K, Cooper J,et al. Liver disease: Hepatitis C. FP Essent, 2021,511:23-28.
[11] Cartwright EJ, Pierret C, Minassian C,et al. Alcohol use and sustained virologic response to hepatitis C virus direct-acting antiviral therapy. JAMA Netw Open, 2023,(9):e2335715.
[12] Liu CH, Chen CY, Su WW,et al. Sofosbuvir/velpatasvir plus ribavirin for Child-Pugh B and Child-Pugh C hepatitis C virus-related cirrhosis. Clin Mol Hepatol, 2021,27(4):575-588.
[13] Lee WJ, Jones M, Wing PAC,et al. The A150V polymorphism of genotype 3 hepatitis C virus polymerase inhibits interferon alfa by suppressing protein kinase R activation. Cell Mol Gastroenterol Hepatol, 2021,11(4):1163-1175.
[14] Salum GM, Dawood RM, Abd El-Meguid M,et al. Correlation between IL28B/TLR4 genetic variants and HCC development with/without DAAs treatment in chronic HCV patients. Genes Dis, 2019,7(3):392-400.
[15] Da BL, Lourdusamy V, Kushner T,et al. Efficacy of sofosbuvir/velpatasvir/voxilaprevir in direct-acting antiviral experienced patients with hepatitis C virus. Eur J Gastroenterol Hepatol, 2021,33(6):859-861.
[16] 刘爱华,符建,陈小红. 瞬时超声弹性成像联合GGT/PLT比值预测慢性乙型肝炎患者肝纤维化价值研究. 实用肝脏病杂志,2023,26(5):634-637.
[17] Ali RA, Awadalla EA, Amin YA, et al. The deleterious effects of sofosbuvir and ribavirin (antiviral drugs against hepatitis C virus) on different body systems in male albino rats regarding reproductive, hematological, biochemical, hepatic, and renal profiles and histopathological changes. Sci Rep, 2024,14(1):5682.
[18] Gu J, Zhang E, Liang B,et al. Use of direct liver stiffness measurement in evaluating the severity of liver cirrhosis in patients with hepatocellular carcinoma. World J Surg, 2020,44(8):2777-2783.
[19] Yao H, Wang Y. Relationship between hemodynamic parameters and portal venous pressure in cirrhosis patients with portal hypertension. Open Life Sci, 2020,15(1):981-987.
[20] Han H, Yang J, Jin WK,et al. Diagnostic value of conventional ultrasound and shear wave elastography in detecting transjugular intrahepatic portosystemic shunt dysfunction. Acta Radiol, 2021,62(12):1575-1582.
[21] Kotani K, Enomoto M, Uchida-Kobayashi S,et al. Short-term hepatocyte function and portal hypertension outcomes of sofosbuvir/velpatasvir for decompensated hepatitis C-related cirrhosis. J Gastroenterol, 2023,58(4):394-404.
[22] Gaur N, Malhotra V, Agrawal D,et al. Sofosbuvir-velpatasvir fixed drug combination for the treatment of chronic hepatitis C infection in patients with end-stage renal disease and kidney transplantation. J Clin Exp Hepatol, 2020,10(3):189-193.
[23] Zhang M, O'Keefe D, Iwamoto M,et al. High sustained viral response rate in patients with hepatitis C using generic sofosbuvir and daclatasvir in Phnom Penh, Cambodia. J Viral Hepat, 2020,27(9):886-895.

索磷布韦联合维帕他韦治疗丙型肝炎肝硬化患者临床疗效和门脉超声检查指标变化研究^*

Satisfactory response to sofosbuvir and velpatasvir combination regimen in patients with hepatitis C-induced liver cirrhosis

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