不同直接抗病毒药物治疗慢性丙型肝炎及代偿期肝硬化患者的疗效研究

Efficacy of different direct-acting antivirals in treating patients with chronic hepatitis C and compensated liver cirrhosis

摘要:

目的 探讨不同直接抗病毒药物（DAAs）治疗慢性丙型肝炎（CHC）及代偿期肝硬化患者的疗效。方法 选取2021年1月—2023年1月黑龙江省佳木斯市传染病院收治的118例丙型肝炎及其代偿期肝硬化患者。其中CHC患者88例，丙型肝炎代偿期肝硬化（CLC）患者30例，通过基因测序法确定患者丙型肝炎病毒（HCV）基因型。所有患者根据病情接受不同DAAs治疗，比较患者肝功能、病毒转阴情况和不良反应。结果 索磷布韦（SOF）+维帕他韦组、艾尔巴韦（EBR）+格拉瑞韦（GZR）组、奥比帕利（OBV）+达塞布韦（DSV）组、SOF+达拉他韦（DCV）组和SOF+利巴韦林（RBV）组治疗1周和治疗4周的HCV RNA阴转率比较，差异均无统计学意义（P >0.05）。患者治疗后丙氨酸氨基转移酶、天门冬氨酸氨基转移酶水平均较治疗前下降（P <0.05）。患者治疗前与治疗后血肌酐水平比较，差异无统计学意义（P >0.05）。1例患者在使用SOF+RBV治疗1个月后发生溶血，导致全身皮肤和巩膜黄染，之后改用SOF+DCV；2例患者在服用OBV+DSV期间出现全身皮疹，改用EBR+GZR。其他患者的不良反应较轻，包括3例恶心、6例头晕和5例心悸，患者均未因不良反应中断治疗。结论 不同DAAs治疗方案在患者中的长期疗效相似，且对肝功能的改善无差异，治疗过程中不良事件发生率较低。

Abstract:

Objective To investigate the efficacy of different direct-acting antivirals (DAA) in the treatment of patients with chronic hepatitis C (CHC) and compensated liver cirrhosis (CLC).Methods Between January 2021 and January 2023, a total of 118 patients with CHC and CLC were enrolled from our hospital. Among them, 88 had CHC and 30 had CLC. Hepatitis C virus (HCV) genotypes were determined using gene sequencing. All patients received different DAA treatment regimens according to their conditions. The liver function, viral clearance, and adverse reactions were compared.Results The HCV RNA negative conversion rates at week 1 and week 4 of treatment were compared among the sofosbuvir (SOF) + velpatasvir (VEL), elbasvir (EBR) + grazoprevir (GZR), ombitasvir (OBV) + dasabuvir (DSV), SOF + daclatasvir (DCV), and SOF + ribavirin (RBV) groups, with no statistically significant differences observed (all P > 0.05). Post-treatment levels of alanine aminotransferase and aspartate aminotransferase were significantly lower than pre-treatment levels (P < 0.05). There was no significant difference in serum creatinine levels before and after treatment (P > 0.05). One patient developed hemolysis after 1 month of treatment with SOF + RBV, resulting in generalized jaundice and scleral icterus, and was subsequently switched to SOF + DCV. Two patients experienced generalized rash during treatment with OBV + DSV and were switched to EBR + GZR. Other adverse reactions were mild, including nausea in 3 patients, dizziness in 6 patients, and palpitations in 5 patients, and none of the patients discontinued treatment due to adverse events.Conclusion Different DAA regimens demonstrate comparable long-term efficacy, similar effects on liver function, and a low incidence of adverse events during treatment.