摘要
目的观察直接抗病毒药物(DAAs)治疗肝移植术后丙型肝炎病毒(HCV)感染受者的抗病毒疗效。方法收集2014年12月至2018年6月解放军总医院第五医学中心收治的应用DAAs治疗的肝移植术后HCV感染受者22例临床资料进行回顾性分析,HCV RNA基因1b型患者20例,采用索磷布韦(400 mg/d)+来迪派韦(90 mg/d)或索磷布韦(400 mg/d)+达拉他韦(60 mg/d)治疗方案,疗程12周或24周;2a型患者2例,采用索磷布韦(400 mg/d)治疗方案,疗程12周。观察抗病毒治疗效果、治疗期间的不良反应以及治疗、随访过程中的HCV RNA定量、肝肾功能等实验室指标。结果22例肝移植术后HCV感染受者中男性16例,女性6例,中位年龄61.5(36~71)岁,抗病毒治疗中位时间为移植术后48(2~117)个月。其中16例患者采用12周疗程,治疗4周时2例患者HCV RNA未阴转,治疗结束时所有患者HCV RNA定量均为阴性;6例患者采用24周疗程(均为1b基因型),治疗4周及治疗结束时HCV RNA均为阴性;所有患者治疗结束后12周及24周持续病毒学应答率均为100.0%。患者治疗前的血清丙氨酸氨基转移酶(ALT)和肌酐水平分别为71.5(30,110)U/L、(89.4±25.7)mmol/L,治疗4周后ALT下降为22(17.8,28.5)U/L,治疗结束后24周肌酐下降为(77.4±11.5)mmol/L,治疗前后比较差异均有统计学意义(均P<0.05)。治疗期间无严重不良反应发生。结论DAAs治疗肝移植术后HCV感染抗病毒效果肯定,可获得长期持续病毒学应答。
Objective To investigate the antiviral efficacy of direct-acting antiviral agents(DAAs)in the treatment of liver transplantation(LT)recipients with hepatitis C virus(HCV)infection.Methods Twenty-two HCV-infected LT recipients treated with DAAs at Fifth Medical Center of Chinese PLA General Hospital from December 2014 to June 2018 were retrospectively analyzed,Twenty cases of HCV RNA gene type 1b were treated with sofosbuvir(400 mg/d)+ledipasvir(90 mg/d)or sofosbuvir(400 mg/d)+daclatasvir(60 mg/d)for 12 weeks or 24 weeks;2 cases of gene type 2a were treated with sofosbuvir(400 mg/d)for 12 weeks.The effect of antiviral treatment,adverse reactions during treatment,and laboratory indicators such as HCVRNA quantification,blood routine,liver and kidney function during treatment and follow-up were studied.Results The LT recipients of HCV infection included 16 males and 6 females,with a median age of 61.5(36-71)years old,and the median time of antiviral treatment was 48(2-117)months after transplantation.Among the 22 patients,16 received a 12-week course of treatment.Except for 2 patients who did not get HCVRNA negative conversion at 4-week,all achieved a negative HCV RNA at 4-week and the end of the treatment.Six LT recipients received a 24-week course of treatment(gene type 1b),and HCVRNA was negative at 4-week and the end of treatment.All patients achieved end of treatment virological response and a sustained virological response(SVR)rate of 100%at 12 weeks and 24 weeks after the end of treatment.The serum levels of alanine aminotransferase(ALT)and creatinine were 71.5(30,110)U/L and(89.4±25.7)mmol/L before treatment,respectively.ALT decreased to 22(17.8,28.5)U/L after 4 weeks of treatment,and serum creatinine decreased to(77.4±11.5)mmol/L at 24 weeks after the end of treatment.The differences before and after treatment were statistically significant(all P<0.05).No serious adverse events occurred during the treatment.Conclusions DAAs have a definite antiviral effect in the treatment of LT recipients with HCV infecti
作者
汤汝佳
张宁
周霞
张利娟
冯丹妮
贺希
刘振文
周双男
刘鸿凌
Tang Rujia;Zhang Ning;Zhou Xia;Zhang Lijuan;Feng Danni;He Xi;Liu Zhenwen;Zhou Shuangnan;Liu Hongling(Liver Transplantation Center,Fifth Medical Center of Chinese PLA General Hospital,Beijing 100039,China;Department of Integrated TCM&Western Medicine,Fifth Medical Center of Chinese PLA General Hospital,Beijing 100039,China;Department of Liver Disease,Fifth Medical Center of Chinese PLA General Hospital,Beijing 100039,China)
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2021年第5期339-343,共5页
Chinese Journal of Hepatobiliary Surgery
基金
北京市科委科技计划课题(Z161100000116058)
原解放军302医院院内课题(YNKT2014006)。
关键词
肝移植
丙型肝炎病毒
直接抗病毒药物
Liver transplantation
Hepatitis C virus
Direct-acting antiviral
