索磷布韦/维帕他韦联合利巴韦林治疗慢性丙型肝炎患者疗效临床研究

doi:10.3969/j.issn.1672-5069.2021.01.009

摘要/Abstract

摘要： 目的探讨应用索磷布韦/维帕他韦联合利巴韦林治疗慢性丙型肝炎(CHC)患者的疗效及血清细胞毒性T淋巴细胞相关抗原4(CTLA-4)、肿瘤坏死因子α诱导蛋白8样分子2(TIPE2)和白介素-12(IL-12)水平的变化。方法 2018年5月~2019年5月我院肝病科就诊的105例CHC患者,采用随机数字表法将所选患者分为对照组51例和观察组54例,分别给予利巴韦林联合干扰素α-2b或者索磷布韦/维帕他韦联合利巴韦林治疗观察3个月。采用ELISA法检测血清CTLA-4、TIPE2和IL-12水平。结果观察组快速病毒学应答(RVR)率为(88.9%,显著高于对照组(43.1%,P<0.05),早期病毒学应答(EVR)率为90.7%,显著高于对照组(52.9%,P<0.05),治疗结束时应答率为96.3%,显著高于对照组(76.5%,P<0.05),持续病毒学应答(SVR)率为92.6%,显著高于对照组(60.8%,P<0.05);外周血白细胞水平为(5.2±2.0)×10⁹/L,显著高于对照组【(3.4±1.8)×10⁹/L,P<0.05】,红细胞水平为(4.9±0.5)×10⁹/L,显著高于对照组【(4.6±0.7)×10⁹/L,P<0.05】,血小板计数为(113.2±38.6)×10⁹/L,显著高于对照组【(94.7±41.2)×10⁹/L,P<0.05】;血清CTLA-4水平为(1.1±0.4)ng/mL,显著低于对照组【(1.6±0.7)ng/mL,P<0.05】,血清IL-12水平为(29.6±7.3)pg/mL,显著低于对照组【(41.5±11.7)pg/mL,P<0.05】,而血清TIPE2水平为(0.8±0.1)μg/L,显著高于对照组【(0.6±0.3)μg/L,P<0.05】;在治疗期间,观察组不良反应发生率为25.9%,显著低于对照组(94.1%,P<0.05)。结论应用索磷布韦/维帕他韦联合利巴韦林治疗CHC患者疗效好,除强大的抗病毒作用外,可能与该治疗能降低血清CTLA-4和IL-12水平,升高血清TIPE2水平有关。

关键词: 慢性丙型肝炎, 索磷布韦, 维帕他韦, 利巴韦林, 细胞毒性T淋巴细胞相关抗原4, 肿瘤坏死因子α诱导蛋白8样分子2, 白介素-12, 治疗

Abstract: Objective To investigate the clinical efficacy of sofosbuvir/vipatavir and ribavirin combination in the treatment of patients with chronic hepatitis C (CHC). Methods 105 patients with CHC were recruited in the Department of Hepatology in our hospital between May 2018 and May 2019, and were randomly divided into control (n=51) and observation group (n=5), receiving ribavirin and interferon-α-2b, or sofosbuvir/vipatavir and ribavirin combination treatment for three months. Serum cytotoxic T lymphocyte-associated antigen 4 (CTLA-4), tumor necrosis factor alpha-induced protein 8-like molecule 2 (TIPE2), and interleukin-12 (IL-12) levels were detected by ELISA. Results The rapid virologic response (RVR) rate in the observation group was 88.9%, significantly higher than 43.1% (P<0.05) in the control, the early virologic response rate (EVR)was 90.7%, significantly higher than 52.9% (P<0.05) in the control, the end treatment virological response (ETVR) rate was 96.3%, significantly higher than 76.5% (P<0.05) and sustained virologic response (SVR) rate was 92.6%, much higher than 60.8% (P<0.05) in the control; the white blood cell count was (5.2±2.0)×10⁹/L, significantly higher than 【(3.4±1.8)×10⁹/L, P<0.05】, the red blood cell count was (4.9±0.5)×10⁹/L, significantly higher than 【(4.6±0.7)×10⁹/L, P<0.05】, and the platelet count was (113.2±38.6)×10⁹/L, significantly higher than 【(94.7±41.2)×10⁹/L, P<0.05】 in the control; serum CTLA-4 level was (1.1±0.4)ng/mL, much lower than 【(1.6±0.7)ng/mL, P<0.05】, serum IL-12 level was (29.6±7.3)pg/mL, much lower than 【(41.5±11.7)pg/mL, P<0.05】, while serum TIPE2 level was (0.8±0.1)μg/L, significantly higher than 【(0.6±0.3)μg/L, P<0.05】 in the control group; during the treatment period, the incidence of side effects was 25.9%, significantly lower than 94.1% (P<0.05) in the control.Conclusion The application of sofosbuvir/vipatavivir and ribavirin combination in treatment of patients with CHC is efficacious, which might be related to the strong direct anti-viral effect and the reduction of serum CTLA-4 and IL-12 levels, and increase of serum TIPE2 levels.

Key words: Hepatitis C, Sofosbuvir, Vepatavir, Ribavirin, Cytotoxic T lymphocyte associated antigen 4, Tumor necrosis factor alpha inducible protein 8-like molecule 2, Interleukin-12, Therapy

樊秉栋, 张国华, 王君. 索磷布韦/维帕他韦联合利巴韦林治疗慢性丙型肝炎患者疗效临床研究[J]. 实用肝脏病杂志, 2021, 24(1): 31-34.

Fan Bingdong, Zhang Guohua, Wang Jun. An observation of clinical efficacy of sofosbuvir/vipatavir and ribavirin combination in the treatment of patients with chronic hepatitis C[J]. Journal of Practical Hepatology, 2021, 24(1): 31-34.

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