不同直接抗病毒药物方案对基因1b型慢性丙型肝炎及代偿期丙型肝炎肝硬化临床结局的影响

目的探讨不同直接抗病毒药物(DAAs)对基因1b型慢性丙型肝炎(CHC)及丙型肝炎代偿期肝硬化(CLC)临床结局的影响。方法以2018年1月-2018年12月就诊于山西医科大学第一医院感染科门诊的115例基因型1b型CHC(n=91)及CLC(n=24)患者为研究对象。所有患者根据病情均采用DAAs抗病毒治疗,CHC患者中28例采用索磷布韦联合维帕他韦方案,21例采用艾尔巴韦格拉瑞韦片方案,16例采用奥比帕利联合达塞布韦方案,13例采用索磷布韦联合达拉他韦方案,13例采用索磷布韦联合利巴韦林方案;CLC患者中15例采用索磷布韦联合维帕他韦方案,4例采用艾尔巴韦格拉瑞韦片方案,5例采用索磷布韦联合达拉他韦方案。分析2组患者的肝功能复常率及病毒学应答率,并观察药物的不良反应。计量资料组间比较采用t检验,计数资料组间比较采用χ^2检验。结果90.4%的患者在治疗1周时获得超快速病毒学应答,98.2%的患者在治疗4周时获得快速病毒学应答,100%的患者在治疗12周时获得完全早期病毒学应答,100%的患者在治疗结束后12周获得持续病毒学应答;不同抗病毒治疗方案在治疗1周、4周时HCV RNA阴转率差异均无统计学意义(χ^2值分别为2.83、0.07,P值均>0.05)。不同抗病毒方案均可明显改善患者肝功能(ALT和AST复常率),不同组间疗效差异均无统计学意义(χ^2值分别为0.83、1.23,P值均>0.05)。DAAs治疗12周后,2组患者肾功能指标与治疗前相比未见有明显升高或降低,差异均无统计学意义(t值分别为1.32、0.56,P值均>0.05)。不良事件的发生率较低,恶心2例(1.74%),头晕、心悸、皮疹、溶血各1例(0.87%)。结论根据病情采用相应DAAs抗病毒方案治疗1b型患者,均可取得较好的病毒学应答率,肝功能改善显著、不良事件的发生率低。

Effect of different direct-acting antivirals on the clinical outcome of genotype 1b chronic hepatitis C and compensated hepatitis C cirrhosis

Objective To investigate the effect of different direct-acting antivirals(DAAs)on the clinical outcome of genotype 1 b chronic hepatitis C(CHC)and compensated liver cirrhosis(CLC).Methods A total of 115 patients with genotype 1 b CHC and CLC who were treated in Department of Infectious Diseases in The First Hospital of Shanxi Medical University from January to December,2018 were enrolled as subjects,among whom there were 91 patients with CHC and 24 patients with CLC.All patients were given antiviral therapy with DAAs according to their conditions.Among the patients with CHC,28 were treated with sofosbuvir and velpatasvir(SOF+VEL),21 were treated with elbasvir and grazoprevir tablets(EBR+GZR),16 were treated with ombitasvir and dasabuvir(OBV+DSV),13 were treated with sofosbuvir and daclatasvir(SOF+DCV),and 13 were treated with sofosbuvir and ribavirin(SOF+RBV);among the 24 patients with CLC,15 were treated with sofosbuvir and velpatasvir(SOF+VEL),4 were treated with elbasvir and grazoprevir tablets(EBR+GZR),and5 were treated with sofosbuvir and daclatasvir(SOF+DCV).The two groups were compared in terms of normalization rate of liver function and virologic response rate,and adverse drug reactions were observed.The t-test was used for comparison of continuous data between groups,and the chi-square test was used for comparison of categorical data between groups.Results Of all patients,90.4%achieved super-rapid virologic response at 1 week of treatment,98.2%achieved rapid virologic response at week 4 of treatment,100%achieved complete early virologic response at week 12 of treatment,and 100%achieved sustained virologic response at week 12 after the end of treatment.There was no significant difference in HCV RNA seroconversion rate between the patients receiving different antiviral treatment regimens at weeks 1 and 4 of treatment(χ^2=2.83 and 0.07,P>0.05).All antiviral treatment regimens significantly improved the liver function of patients,and there was no significant difference in clinical outcome between different groups(χ^2=0.83 and 1.23,P>0.05).Both groups had no significant increase or reduction in renal function parameters after 12 weeks of the treatment with DAAs(t=1.32 and 0.56,P>0.05).There was a low incidence rate of adverse events,with two cases of nausea(1.74%)and one case each of dizziness,palpitation,rash,and hemolysis(0.87%).Conclusion In patients with genotype 1 b disease,DAA antiviral regimens selected based on their conditions can achieve good virologic response rate,with significant improvement in liver function and a low incidence rate of adverse events.