直接抗病毒药物在急性丙型肝炎治疗中的研究进展

摘要/Abstract

摘要： 丙型肝炎病毒感染的早期,多数患者呈无症状急性感染状态。但55%~85%急性丙型肝炎患者会逐渐发展为慢性丙型肝炎,甚至进展为肝硬化、肝细胞癌,不仅严重威胁患者的生命健康,也给社会带来沉重的医疗负担。直接抗病毒药物在慢性丙型肝炎治疗中已展现卓越的临床疗效。然而,针对急性丙型肝炎的治疗策略,目前临床证据相对有限。研究证实,以格卡瑞韦/哌仑他韦和索磷布韦/维帕他韦为代表的泛基因型直接抗病毒治疗方案效果显著。用于急性丙型肝炎感染时,8~12周疗程即可实现高持续病毒学应答率,且对合并HIV感染或注射吸毒等高危人群同样有效。尽管存在病毒耐药及特殊人群数据不足等问题,但早期抗病毒治疗带来的获益仍显著高于潜在的风险。未来,需进一步拓展直接抗病毒药物适应症范围,优化治疗方案,从而有力推动全球消除丙型肝炎目标的实现。

关键词: 丙型肝炎病毒, 急性丙型肝炎, 直接抗病毒药物, 早期治疗

陈兆, 饶慧瑛. 直接抗病毒药物在急性丙型肝炎治疗中的研究进展[J]. 肝脏, 2025, 30(6): 753-755.

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参考文献

[1] Campollo O, Amaya G, McCormick P A. Milestones in the discovery of hepatitis C[J]. World J Gastroenterol, 2022, 28:5395-5402.
[2] Taha G, Ezra L, Abu-Freha N. Hepatitis C elimination: opportunities and challenges in 2023[J]. Viruses, 2023, 15: 1413.
[3] Fasano M, Ieva F, Ciarallo M, et al. Acute hepatitis C: current status and future perspectives[J]. Viruses, 2024, 16:1739.
[4] Liu C H, Kao J H. Acute hepatitis C virus infection: clinical update and remaining challenges[J]. Clin Mol Hepatol ,2023, 29:623-642.
[5] Domovitz T, Gal-Tanamy M. Tracking down the epigenetic footprint of HCV-induced hepatocarcinogenesis[J]. J Clin Med, 2021, 10:551.
[6] Su J, Zhai Q, Wei D. Recent advancement in small molecules as HCV inhibitors[J]. Bioorg Med Chem, 2022, 60:116699.
[7] Polaris Observatory HCV Collaborators. Global change in hepatitis C virus prevalence and cascade of care between 2015 and 2020: a modelling study[J]. Lancet Gastroenterol Hepatol, 2022, 7:396-415.
[8] 中华医学会肝病学分会, 中华医学会感染病学分会. 丙型肝炎防治指南(2022年版)[J]. 中华肝脏病杂志, 2022, 30: 1332-1348.
[9] European Association for the Study of the Liver. EASL recommendations on treatment of hepatitis C: Final update of the series[J]. J Hepatol, 2020, 73:1170-1218.
[10] Pol S, Thompson A J, Collins M, et al. Effectiveness and safety of glecaprevir/pibrentasvir for 8 weeks in the treatment of patients with acute hepatitis C: a single-arm retrospective study[J]. Hepatology, 2025, 81:1006-1018.
[11] Maasoumy B, Ingiliz P, Spinner C D, et al. Sofosbuvir plus velpatasvir for 8 weeks in patients with acute hepatitis C: the HepNet acute HCVV study[J]. JHEP Rep, 2023, 5:100650.
[12] Matthews G V, Bhagani S, Van der Valk M, et al. Sofosbuvir/velpatasvir for 12 vs. 6 weeks for the treatment of recently acquired hepatitis C infection[J]. J Hepatol, 2021, 75:829-839.
[13] Martinello M, Orkin C, Cooke G, et al. Short-duration pan-genotypic therapy with glecaprevir/pibrentasvir for 6 weeks among people with recent hepatitis C viral infection[J]. Hepatology, 2020, 72:7-18.
[14] Micallef J M, Kaldor J M, Dore G J. Spontaneous viral clearance following acute hepatitis C infection: a systematic review of longitudinal studies[J]. J Viral Hepat, 2006, 13:34-41.
[15] Martinello M, Hajarizadeh B, Grebely J, et al. Management of acute HCV infection in the era of direct-acting antiviral therapy[J]. Nat Rev Gastroenterol Hepatol, 2018, 15:412-424.
[16] Borgia S M, Dearden J, Yoshida E M, et al. Sofosbuvir/velpatasvir for 12 weeks in hepatitis C virus-infected patients with end-stage renal disease undergoing dialysis[J]. J Hepatol, 2019, 71:660-665.
[17] Cornberg M, Wedemeyer H. Early treatment of acute or recently acquired hepatitis C: an important tool on the path to HCV elimination![J]. Hepatology, 2025, 81:771-773.
[18] Howe A Y M, Rodrigo C, Cunningham E B, et al. Characteristics of hepatitis C virus resistance in an international cohort after a decade of direct-acting antivirals[J]. JHEP Rep, 2022, 4:100462.
[19] Willemse S B, Razavi-Shearer D, Zuure F R, et al. The estimated future disease burden of hepatitis C virus in the Netherlands with different treatment paradigms[J]. Neth J Med,2015, 73:417-431.
[20] Chappell C A, Scarsi K K, Kirby B J, et al. Ledipasvir plus sofosbuvir in pregnant women with hepatitis C virus infection: a phase 1 pharmacokinetic study[J]. Lancet Microbe, 2020, 1:e200-e208.