乙型肝炎病毒/丙型肝炎病毒共同感染患者临床特征及其对抗病毒治疗应答反应研究*

doi:10.3969/j.issn.1672-5069.2024.04.008

摘要/Abstract

摘要： 目的分析乙型肝炎病毒(HBV)/丙型肝炎病毒(HCV)共同感染患者临床特征及其对抗病毒治疗应答情况。方法 2020年1月～2021年12月我院收治的慢性乙型肝炎(CHB)患者40例、慢性丙型肝炎(CHC)患者24例和CHB/CHC患者17例,分别给予恩替卡韦、索磷布韦/维帕他韦或恩替卡韦联合索磷布韦/维帕他韦48 w或24 w,随访24 w。采用实时荧光定量PCR法或RT-PCR法检测血清HBV DNA或HCV RNA载量,使用流式细胞仪检测外周血T淋巴细胞亚群。结果在17例CHB/CHC患者中,有HBV感染家族史、HCV感染家族史、输血史3例和药物滥用分别占41.2%、23.6%、17.6%和17.6%,慢性肝炎、代偿期和失代偿期肝硬化分别占70.6%、23.6%和5.8%;在治疗前,CHB/CHC患者血清ALT和AST水平均显著高于CHB或CHC患者,而血清HBV DNA载量显著低于CHB患者,血清HCV RNA载量显著低于CHC患者(P＜0.05),在治疗后,CHB/CHC患者血清ALT和AST水平仍显著高于CHB或CHC患者(P＜0.05),而三组血清病毒载量比较,无显著性差异(P>0.05);治疗前后,CHB/CHC患者外周血CD3⁺和CD4⁺细胞百分比及CD4⁺/CD8⁺细胞比值均显著低于CHB或CHC患者(P＜0.05);在随访24 w末,三组患者均未发生病毒学突破或病情复发情况。结论本研究未观察到CHB合并CHC患者临床病情与CHB或CHC患者有显著区别,对抗病毒治疗应答良好,其远期疗效和临床结局还需要进一步观察。

关键词: 慢性乙型肝炎, 慢性丙型肝炎, 共同感染, 临床特征, 抗病毒治疗

Abstract: Objective The aim of this study was to investigate the clinical feature and responses to antiviral therapy in patients with hepatitis B virus (HBV) and hepatitis C virus (HCV)co-infection. Methods 40 patients with chronic hepatitis B (CHB), 24 patients with chronic hepatitis C (CHC) and 17 patients with CHB/CHC were enrolled in our hospital between January 2020 and December 2021, receiving entevavir (ETV), sophobuvir/vipatavir or combination of ETV and sophobuvir/vipatavir for 48 weeks or 24 weeks. Entecavir therapy continued after finishing anti-HCV treatment, and all patients were followed-up for 24 weeks. Serum HBV DNA and HCV RNA loads were detected, and peripheral blood T lymphocyte subsets were determined by FCM. Results Of 17 patients with CHB/CHC, there were family HBV infection history in 41.2%, HCV infection history in 23.6%, blood transfusion history in 17.6% and drug abuse in 17.6%, and the clinical phenotypes included CHB in 70.6%, compensated and decompensated liver cirrhosis in 23.6% and 5.8%; at admission, serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels in patients with CHB/CHC were both significantly greater than in those with CHB or with CHC, while serum HBV DNA load were much lower than in patients with CHB and serum HCV RNA load were much lower than in those with CHC(P＜0.05); at end of 24 week follow-up, serum ALT/AST levels in patients with CHB/CHC were still much higher than in those with CHB or in with CHC(P＜0.05), however, there were no significant differences as respect to serum viral loads among the three groups (P>0.05); before and after antiviral treatment, percentages of peripheral blood CD3⁺ and CD4⁺ cells as well as ratio of CD4⁺/CD8⁺ cells in patients with CHB/CHC were significantly lower than in those with CHB or with CHC(P＜0.05); at end of 24 week follow-up, there were no virological breakthrough, or disease relapse in the three groups. Conclusion The clinical discrepancy in patients with CHB and CHC as compared to those with CHB or CHC might be slight, and response to antiviral therapy is promising. The long-term outcomes need further investigation.

Key words: Chronic hepatitis B, Chronic hepatitis C, Co-infection, Antiviral therapy

张丽, 陈雅雯, 盖琳, 邱红, 甄鑫, 常静霞. 乙型肝炎病毒/丙型肝炎病毒共同感染患者临床特征及其对抗病毒治疗应答反应研究^*[J]. 实用肝脏病杂志, 2024, 27(4): 523-526.

Zhang Li, Chen Yawen, Gai Lin, et al. Clinical feature and responses to antiviral therapy in patients with hepatitis B virus and hepatitis C virus co-infection[J]. Journal of Practical Hepatology, 2024, 27(4): 523-526.

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乙型肝炎病毒/丙型肝炎病毒共同感染患者临床特征及其对抗病毒治疗应答反应研究^*

Clinical feature and responses to antiviral therapy in patients with hepatitis B virus and hepatitis C virus co-infection

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