肝移植术后丙型肝炎复发患者抗病毒疗效及影响因素分析

目的研究小剂量递增方案对肝移植术后丙型肝炎复发患者的抗病毒治疗效果。方法对我院收治的21例因HCV相关终末期肝病行肝移植术后复发丙型肝炎的患者,采用干扰素联合利巴韦林小剂量递增方案进行抗病毒治疗。观察治疗后快速病毒学应答、完全早期病毒学应答、治疗结束时病毒学应答(end of treatment virological response,ETVR)、持续病毒学应答(sustained virological response,SVR)以及抗病毒治疗的不良反应。结果抗病毒治疗开始时间为术后2～59个月,21例中5例(23.8%)为标准治疗,4例(19.1%)为足疗程,12例(57.1%)为不完全治疗。获得ETVR 16例(76.2%),SVR 5例(23.8%)。标准治疗组、足疗程治疗组和不完全治疗组之间相比,ETVR获得率无显著差异,而SVR获得率差异显著(P=0.002)。治疗前病毒载量和抗病毒治疗的剂量和疗程是影响获得SVR的重要因素。治疗过程中10例须采用粒细胞集落刺激因子维持治疗,2例出现排斥反应。结论肝移植术后丙型肝炎复发患者对干扰素联合利巴韦林抗病毒治疗耐受性差。抗病毒药物的剂量和疗程是影响获得SVR的重要因素。

Effect of antiviral therapy and the factors influencing the therapeutic effect in patients with HCV recurrence after liver transplantation

Objective To investigate the effect of antiviral therapy with low accelerating dose regimen(LADR) in patients with HCV recurrence after liver transplantation.Methods Twenty-one patients with HCV recurrence after liver transplantation due to HCV-related end-stage liver disease admitted to our hospital were treated with LADR using interferon in combination with riba-virin.Rapid virological response,complete early virological response,end of treatment virological response(ETVR),sustained viro-logical response(SVR) and adverse effect of the antiviral therapy were observed.Results Antiviral therapy started 2 to 59 months after orthotopic liver transplantation.Of 21 patients,5(23.8%) underwent standard treatment,4(19.1%) full duration of treatment and 12(57.1%) incomplete treatment.ETVR and SVR were achieved in 16 patients(76.2%) and 5 patients(23.8%),respectively.ETVR rate was not significantly different and SVR rate was significantly different among standard treatment group,full duration of treatment group and incomplete treatment group(P=0.002).HBV RNA level and the dose and duration of the antiviral therapy were the major factors influencing the attainment of SVR.During the antiviral therapy,10 patients needed granulocyte colony stimulating factor to maintain treatment and 2 were diagnosed with acute rejection.Conclusions Tolerability of antiviral combination therapy with inter-feron and ribavirin is poor in patients with HCV recurrence after liver transplantation.The dosage of antiviral agents and treatment duration are the important factors affecting SVR.