直接抗病毒药物治疗基因1b型慢性丙型肝炎合并2型糖尿病患者疗效及对血糖控制的影响*

doi:10.3969/j.issn.1672-5069.2023.03.011

摘要/Abstract

摘要： 目的评价应用直接抗病毒药物(DAAs)治疗基因1b型慢性丙型肝炎(CHC)合并2型糖尿病(T2DM)患者疗效及其对血糖控制的影响。方法 2018年5月～2022年1月我院诊治的基因1b型CHC合并T2DM患者62例,采用随机数字表法将患者分为观察组和对照组,各31例,在常规降糖治疗的基础上,分别给予索磷布韦维帕他韦或聚乙二醇干扰素-α联合利巴韦林片方案治疗,均连续治疗观察24周,随访24周。疗效判定包括早期病毒学应答(EVR)、治疗结束时病毒学应答(ETVR)和持续病毒学应答(SVR)。检测肝功能、空腹血糖(FPG)、糖化血红蛋白(HbA1c)、空腹胰岛素和空腹C肽,计算稳态模型胰岛素抵抗指数(HOMA-IR)。结果观察组EVR、ETVR和SVR分别为87.1%、100.0%和96.8%,均显著高于对照组(分别为58.1%、71.0%和64.5%,P<0.05);在治疗24 w末,观察组血清ALT、AST和GGT水平分别为35(23,47)U/L、31(19,47)U/L和62(38,81)U/L,均显著低于对照组【分别为39(36,57)U/L、42(34,64)U/L和80(47,104)U/L,P<0.05】;观察组FPG、HbA1c、HOMA-IR和空腹C肽水平分别为6.1(5.0,7.9)mmol/L、7.1(6.0,9.2)%、2.2(1.8,3.1)和1.6(1.2,2.2)ng/ml,均显著低于对照组【分别为7.1(5.5,9.4)mmol/L、7.8(6.4,9.4)%、2.8(2.1,3.4)和2.2(1.6,2.4)ng/ml,P<0.05】。结论应用索磷布韦联合维帕他韦治疗基因1b型CHC合并T2DM患者疗效确切,同时血糖控制也较为理想。

关键词: 慢性丙型肝炎, 基因1b型, 2型糖尿病, 直接抗病毒药物, 索磷布韦/维帕他韦, 持续病毒学应答, 治疗

Abstract: Objective The aim of this study was to observe the antiviral efficacy and blood glucose control of direct acting antivirals (DAAs) in treatment of patients with genotype 1b chronic hepatitis C (CHC) and type 2 diabetes mellitus(T2DM). Methods 62 patients (42 naïve and 20 re-treated) with CHC and T2DM with genotype 1b HCV infection were recruited in our hospital between May 2018 and January 2022, and were randomly divided into observation and control group, with 31 cases in each group. The patients with CHC in the observation group were treated with oral sofosbuvir/velpasvir administration, and those in the control were treated with peginterferon-α and ribavirin combination. The regimen in both groups lasted for 24 weeks, and all patients were followed-up for 24 weeks after discontinuation of the treatment. The antiviral efficacy was determined as for early virological response (EVR), virological response at the end of treatment (ETVR) and sustained virological response (SVR). The liver function tests, fasting blood glucose (FPG), glycosylated hemoglobin (HbA1c), fasting insulin and fasting C-peptide levels were measured, and the steady-state model insulin resistance index (HOMA-IR) was calculated. Results The EVR, ETVR and SVR in the observation group were 87.1%, 100.0% and 96.8%, all significantly higher than 58.1%, 71.0% and 64.5% (P<0.05) in the control; at the end of 24 week treatment, serum ALT, AST and GGT levels in the observation group were 35(23, 47)U/L, 31(19, 47)U/L and 62(38, 81)U/L, all significantly lower than [39(36, 57)U/L, 42(34, 64)U/L and 80(47, 104)U/L, P<0.05] in the control; the FPG, serum HbA1c, HOMA-IR and fasting serum C peptide levels in the observation group were 6.1(5.0, 7.9)mmol/L, 7.1(6.0, 9.2)%, 2.2(1.8, 3.1) and 1.6(1.2, 2.2)ng/ml, all significantly lower than [7.1(5.5, 9.4)mmol/L, 7.8(6.4, 9.4)%, 2.8(2.1, 3.4) and 2.2(1.6, 2.4)ng/ml, P<0.05] in the control group. Conclusion The oral administration of sofosbuvir and velpasvir combination treatment is efficacious in patients with CHC with genotype 1b HCV infection and T2DM , which seems not impacting the blood sugar control.

Key words: Hepatitis C, Genotype 1b HCV infection, Type 2 diabetes mellitus, Direct acting antivirals, Sofosbuvir and velpasvir, Sustained virological response, Therapy

王云云, 吴万锋, 李黎. 直接抗病毒药物治疗基因1b型慢性丙型肝炎合并2型糖尿病患者疗效及对血糖控制的影响^*[J]. 实用肝脏病杂志, 2023, 26(3): 344-347.

Wang Yunyun, Wu Wanfeng, Li Li. Antiviral efficacy and impact on blood glucose control of direct acting antivirals in treatment of patients with genotype 1b chronic hepatitis C and type 2 diabetes mellitus[J]. Journal of Practical Hepatology, 2023, 26(3): 344-347.

参考文献

[1] Abraham GM, Obley AJ, Humphrey LL, et al. World Health Organization guidelines on treatment of hepatitis C virus infection: Best practice advice from the American College of Physicians. Ann Intern Med, 2021, 174(1):98-100.
[2] Lazarus JV, Roel E, Elsharkawy AM. Hepatitis C virus epidemiology and the impact of interferon-free hepatitis C virus therapy. Cold SpringHarb Perspect Med, 2020, 10(3):a036913.
[3] Ambachew S, Eshetie S, Geremew D, et al. Prevalence of type 2 diabetes mellitus among hepatitis C virus-infected patients: a protocol for systematic review and meta-analysis. Syst Rev, 2019, 8(1):60.
[4] Hsu WH, Sue SP,Liang HL, et al. Dipeptidyl peptidase 4 inhibitors decrease the risk of hepatocellular carcinoma in patients with chronic hepatitis C infection and type 2 diabetes mellitus: A nationwide study in Taiwan. Front Public Health, 2021, 9:711723.
[5] Naing C, Mak JW, Ahmed SI, et al. Relationship between hepatitis C virus infection and type 2 diabetes mellitus: meta-analysis. World J Gastroenterol, 2012, 18(14):1642-1651.
[6] Kawaguchi T, Yoshida T, Harada M, et al. Hepatitis C virus down-regulates insulin receptor substrates 1 and 2 through up-regulation of suppressor of cytokine signaling 3. Am J Pathol, 2004, 165(5):1499-1508.
[7] Walsh MJ, Jonsson JR, Richardson MM, et al. Non-response to antiviral therapy is associated with obesity and increased hepatic expression of suppressor of cytokine signaling 3 (SOCS-3) in patients with chronic hepatitis C, viral genotype 1. Gut, 2006, 55(4):529-535.
[8] Xie Q, Xuan JW, Tang H, et al. Hepatitis C virus cure with direct acting antivirals: Clinical, economic, societal and patient value for China. World J Hepatol, 2019, 11(5):421-441.
[9] Li T, Qu Y, Guo Y, et al. Efficacy and safety of direct-acting antivirals-based antiviral therapies for hepatitis C virus patients with stage 4-5 chronic kidney disease: a meta-analysis. Liver Int, 2017, 37(7):974-981.
[10] Ji F, Li J, Liu L, et al. High hepatitis C virus cure rates with approved interferon-free direct-acting antivirals among diverse mainland Chinese patients including genotypes 3a and 3b. J Gastroenterol Hepatol, 2021, 36(3):767-774.
[11] 中华医学会肝病学分会和感染病学分会.《丙型肝炎防治指南》2015年更新版.实用肝脏病杂志,2016,19(4):IX-XXVI.
[12] 中华医学会肝病学分会和感染病学分会.《丙型肝炎防治指南》2015年更新版.实用肝脏病杂志,2016,19(4):IX-XXVI.
[13] 中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2020年版). 中华糖尿病杂志, 2021, 13(4):315-409.
[14] Moucari R, Forestier N, Larrey D, et al. Danoprevir, an HCV NS3/4A protease inhibitor, improves insulin sensitivity in patients with genotype 1 chronic hepatitis C. Gut, 2010, 59(12):1694-1698.
[15] Pavone P, Tieghi T, d'Ettorre G, et al. Rapid decline of fasting glucose in HCV diabetic patients treated with direct-acting antiviral agents. Clin Microbiol Infect, 2016, 22(5):462.e1-462,e4623.
[16] Premji R, Roopnarinesingh N, Qazi N, et al. New-onset diabetes mellitus with exposure to ledipasvir and sofosbuvir. J Investig Med High Impact Case Rep, 2015, 3(4):2324709615623300.
[17] Pashun RA, Shen NT, Jesudian A. Markedly improved glycemic control in poorly controlled type 2 diabetes following direct acting antiviral treatment of genotype 1 hepatitis C. Case Reports Hepatol, 2016, 2016:7807921.
[18] Vanni E, Bugianesi E, Saracco G. Treatment of type 2diabetes mellitus by viral eradication in chronic hepatitis C: Myth or reality? Dig Liver Dis, 2016, 48(2):105-111.
[19] Chehadeh W, Abdella N, Ben-Nakhi A, et al. Risk factors for the development of diabetes mellitus in chronic hepatitis C virus genotype 4 infection. J Gastroenterol Hepatol, 2009, 24(1):42-48.
[20] Thompson AJ, Patel K, Chuang WL, et al. Viral clearance is associated with improved insulin resistance in genotype 1 chronic hepatitis C but not genotype 2/3. Gut, 2012, 61(1):128-134.
[21] Margusino-Framiñán L, Cid-Silva P, Giménez-Arufe V, et al. Influence of drug-drug interactions on effectiveness and safety of direct-acting antivirals against hepatitis C virus. Eur J Hosp Pharm, 2021, 28(1):16-21.

直接抗病毒药物治疗基因1b型慢性丙型肝炎合并2型糖尿病患者疗效及对血糖控制的影响^*

Antiviral efficacy and impact on blood glucose control of direct acting antivirals in treatment of patients with genotype 1b chronic hepatitis C and type 2 diabetes mellitus

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