直接抗病毒药物治疗丙型肝炎肝硬化早期抗病毒疗效及安全性临床实践研究

目的评价直接抗病毒药物(direct-acting antiviral agents,DAAs)治疗丙型肝炎肝硬化的早期抗病毒疗效及安全性。方法给予基因1b型丙型肝炎肝硬化患者DAAs抗病毒治疗。方案1:sofosbuvir+ribavirin(RBV);方案2:sofosbuvir+ledipasvir+RBV;方案3:sofosbuvir+daclatasvir+RBV,疗程均为24周。观察不同治疗时间点的病毒学和生物化学指标变化以及患者的不良反应。本研究先期分析24例患者12周的数据。结果完成12周治疗的24例患者中,方案1组12例,方案2组和方案3组均为6例。24例应用DAAs治疗1、2、4和12周HCV转阴率分别是25.00%(6/24)、45.83%(11/24)、66.67%(16/24)和70.83%(17/24),随着治疗时间的延长,HCV转阴率逐渐上升。方案1组中,初治和经治患者治疗12周时HCV转阴例数分别为4例和1例;方案2和3组中,初治和经治患者治疗12周时HCV转阴例数均为3例。截至2016年1月,有3例随访至停药12周,1例在方案1组,该患者停药12周后复发,HCV RNA为1.8×106 IU/ml;2例在方案2组,达到治疗12周持续病毒学应答,HCV RNA未检测到。DAAs治疗2周后ALT降到正常值范围,12周时仍在正常值范围。治疗1周时CK和CK-MB稍有上升,但差异无统计学意义,2周后降到正常值范围,12周时仍在正常值范围。在DAAs治疗过程中,BUN和CRE无显著性升高,无须调整DAA剂量。DAAs常见的不良反应是恶心(58.83%)。结论基因1b型丙型肝炎肝硬化患者应用DAAs抗病毒治疗早期疗效好,安全性高。对于经治患者应用sofosbuvir联合ledipasvir或daclatasvir。

Early efficacy and safety of direct-acting antiviral agents for the treatment of cirrhotic patients with hepatitis C

Objective To evaluate early efficacy and safety of direct-acting antiviral agents (DAAs) for the treatment of cirrhotic patients with hepatitis C.Methods HCV genotype 1b patients with cirrhosis were treated with DAAs [treatment protocol 1: sofosbuvir+ribavirin (RBV), treatment protocol 2: sofosbuvir+ledipasvir+RBV, treatment protocol 3: sofosbuvir+daclatasvir+RBV] for 24 weeks. Virological and biochemical markers were monitored at different time points, and adverse reactions were observed. This study focused on the analysis of the data obtained from 24 patients receiving 12 weeks of treatment.Results Of 24 patients, who had completed 12 weeks of treatment, 12 received treatment protocol 1, 6 treatment protocol 2, and the other 6 treatment protocol 3. Negative conversion rates of HCV RNA at week 1, 2, 4 and 12 were 25.00% (6/24), 45.83% (11/24), 66.67% (16/24) and 70.83% (17/24), respectively. Prolonged DAAs treatment resulted in an increased negative conversion rate of HCV RNA. Of patients receiving treatment protocol 1, HCV RNA negative conversion was obtained in 4 na?ve patients and 1 experienced patient at week 12 of treatment. Of patients receiving treatment protocol 2 and 3, HCV RNA negative conversion was obtained in 3 na?ve patients and 3 experienced patients at week 12 of treatment, respectively. As of January 2016, 3 patients were followed up for 12 weeks after medication cessation, of whom the 1 patient receiving treatment protocol 1 relapsed after medication cessation for 12 weeks with HCV RNA of 1.8×106 IU/ml, and the other 2 patients receiving treatment protocol 2 achieved sustained virological response with HCV RNA undetectable. ALT decreased to normal after 2 weeks of treatment and kept normal at week 12. Both CK and CK-MB elevated slightly after 1 week of treatment, but there were no significant differences at baseline and week 1. The two markers decreased to normal after 2 weeks of treatment and kept normal at week 12. BUN and CRE didn't increase during DAAs treatment, so there was no need to adjust the dose of DAAs. The common adverse reaction was nausea (58.83%).Conclusions DAAs treatment achieves good early efficacy and safety in HCV genotype 1b patients with cirrhosis. Treatment-experienced patients should be given a combination of sofosbuvir plus ledipasvir or daclatasvir.