泛基因型与特异基因型DAAs方案精准治疗基因1b型慢性丙型肝炎患者疗效对比分析*

doi:10.3969/j.issn.1672-5069.2022.03.013

摘要/Abstract

摘要： 目的比较采用泛基因型与特异基因型直接抗病毒药物(DAAs)方案精准治疗基因1b型慢性丙型肝炎(CHC)患者的疗效。方法 2018年1月～2020年6月我院诊治的基因1b型CHC患者75例,其中34例对照组患者接受泛基因型DAAs治疗,即19例接受索非布韦/维帕他韦口袋,15例口服索磷布韦/达拉他韦;41例研究组接受特异基因型DAAs治疗,即23例口服艾尔巴韦/格拉瑞韦,18例口服奥比帕利/达塞布韦。两组均持续治疗12周。采用实时荧光定量PCR法检测血清HCV RNA。比较两组超快速病毒学应答(SRVR)、快速病毒学应答(RVR)、早期病毒学应答(EVR)和持续病毒学应答(SVR)。结果在治疗12周末,研究组血清ALT和AST水平分别为(31.9±4.1)U/L和(32.5±4.1)U/L,与对照组[分别为(32.7±4.2)U/L和(31.9±3.7)U/L,P＞0.05]比,无显著性差异;研究组SRVR、RVR、EVR和SVR分别为87.8%、97.6%、100.0%和100.0%,与对照组(分别为88.2%、94.1%、100.0%和100.0%)比,差异均无统计学意义(P＞0.05);索非布韦/维帕他韦治疗患者SRVR、RVR、EVR和SVR分别为84.2%、100.0%、100.0%和100.0%,索磷布韦/达拉他韦治疗患者分别为86.7%、93.3%、100.0%和100.0%,艾尔巴韦/格拉瑞韦治疗患者分别为91.3%、100.0%、100.0%和100.0%,奥比帕利/达塞布韦治疗患者分别为88.9%、94.4%、100.0%和100.0%,四组所有病毒学应答率均无显著性差异(P＞0.05);治疗期间两组不良反应发生率为11.8%对12.2%,差异无统计学意义(P＞0.05)。结论当前应用的无论是泛基因型还是特异基因型DAAs方案治疗基因1b型CHC患者均具有良好的疗效,且安全性良好。是否可以不区分感染病毒基因型选择药物治疗,值得进一步研究。

关键词: 慢性丙型肝炎, 直接抗病毒药物, 基因1b型, 治疗

Abstract: Objective The purpose of this study was to compare the virologic response in patients with chronic hepatitis C (CHC) and hepatitis C viral genotype 1b infection receiving pan-genotype or precise genotype-specific direct antiviral agent (DAA) therapy. Methods 75 patients with CHC and genotype 1b HCV infection were enrolled in our hospital between January 2018 and June 2020, and were divided into control (n=34) and study group (n=41). The patients in the control group were given the pan-genotype DAAs regimen, e.g., sofibovir/vapatavir in 19 cases and sufosbuvir/ velpatasvir in 15 cases, and the patients in the study group received precise genotype-specific DAAs regimen, e.g., elbasvir/grazoprevir in 23 cases, and ombitasvir/dasabuvir in 18 cases. The antiviral treatment lasted for 12 weeks. The super-rapid virologic response (SRVR), rapid virologic response (RVR), early virologic response (EVR) and sustained virologic response (SVR) were compared between the two groups. Results At the end of 12 week treatment, serum ALT and AST levels in the study group were (31.9±4.1)U/L and (32.5±4.1)U/L, not significantly different compared to (32.7±4.2)U/L and (31.9±3.7)U/L (P＞0.05) in the control group; the SRVR, RVR, EVR and SVR in the study group were 87.8%, 97.6%, 100.0% and 100.0%, all not significantly different compared to 88.2%, 94.1%, 100.0% and 100.0% in the control (P＞0.05); the SRVR, RVR, EVR and SVR in sofibovir/vapatavir-treated patients were 84.2%, 100.0%, 100.0% and 100.0%, those in sufosbuvir/ velpatasvir-treated patients were 86.7%, 93.3%, 100.0% and 100.0%, in elbasvir/grazoprevir-treated patients were 91.3%, 100.0%, 100.0% and 100.0%, and in ombitasvir/dasabuvir-treated patients were 88.9%, 94.4%, 100.0% and 100.0%, all not significantly different among the four groups(P＞0.05); the incidences of complications during the antiviral treatment were 11.8% vs. 12.2% between the two groups (P＞0.05). Conclusion At present, the pan-genotype and precise genotype- specific DAAs regimens both have a very good antiviral efficacy in CHC patients with genotype 1b infection, with a pleasant safety.

Key words: Hepatitis C, Direct antiviral agents, Genotype 1b, Therapy

柴晓哲, 朱霞峰, 骆成林, 王少峰. 泛基因型与特异基因型DAAs方案精准治疗基因1b型慢性丙型肝炎患者疗效对比分析^*[J]. 实用肝脏病杂志, 2022, 25(3): 355-358.

Chai Xiaozhe, Zhu Xiafeng, Luo Chenglin, et al. Comparison of virologic response in patients with chronic hepatitis C and hepatitis C viral genotype 1b infection receiving pan-genotype or precise genotype-specific direct antiviral agent therapy[J]. Journal of Practical Hepatology, 2022, 25(3): 355-358.

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泛基因型与特异基因型DAAs方案精准治疗基因1b型慢性丙型肝炎患者疗效对比分析^*

Comparison of virologic response in patients with chronic hepatitis C and hepatitis C viral genotype 1b infection receiving pan-genotype or precise genotype-specific direct antiviral agent therapy

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