慢性丙型肝炎患者接受DAAs治疗实现快速病毒学应答后代谢、肾脏和血液学变化

摘要/Abstract

摘要： 目的分析慢性丙型肝炎(CHC)患者接受直接抗病毒药物(DAAs)治疗实现快速病毒学应答后代谢、肾脏和血液学变化,为今后CHC治疗提供临床数据。方法纳入2022年1月—2024年1月我院收治的CHC患者84例。本次DAAs方案主要包括:来迪派韦/索磷布韦(LDV/SOF),共计27例;索磷布韦维帕他韦片(VEL/SOF),共计57例。治疗周期为12周。比较DAAs治疗前后CHC血生化指标变化;定义血红蛋白(Hb)<130 g/L(男性)/120 g/L(女性)为贫血,比较DAAs治疗后不同贫血状态CHC患者的临床资料,并分析影响Hb降低的因素。结果与基线时比,DAAs治疗12周后,PLT、ALT、AST、ALP、TBil、FIB-4、HDL、LDL、尿酸、TG、TC、Glu、HbA₁c及GFR差异具有统计学意义(P<0.05),以上指标均得到显著改善,而Hb显著低于基线时(P<0.05)。治疗12周后,84例CHC患者中出现贫血27例,为贫血组,其余57例为非贫血组。比较两组临床资料发现,女性、年龄、肝硬化、FIB-4及GFR差异具有统计学意义(P<0.05)。将上述差异性临床资料纳入多因素logistic分析,结果得出女性、年龄、FIB-4及肝硬化是CHC患者DAAs治疗后Hb降低的危险因素(P<0.05),而GFR则是保护性因素(P<0.05)。结论接受DAAs治疗后实现快速病毒学应答的CHC患者,其肝功能、代谢指标以及肾功能情况得到有效改善,同时观察到接近1/3的病例发生贫血,其中女性、年龄、FIB-4及肝硬化是CHC患者DAAs治疗后Hb降低的危险因素,而GFR则是保护性因素。

关键词: 慢性丙型肝炎, 直接抗病毒药物, 快速病毒学应答, 贫血

Abstract: Objective To analyze the efficacy and safety of sofosbuvir/velpatasvir in the treatment of children and adolescent patients with chronic hepatitis C (CHC). Methods A retrospective analysis was conducted on the medical records of 153 children and adolescents with CHC admitted to the hospital from March 2022 to January 2024. They were divided into an observation group (n=78) and a control group (n=75) according to different treatment methods. The efficacy, changes in liver function and liver fibrosis indexes and occurrence of adverse reactions in the two groups were compared. Results The sustained virological response at 24 weeks (SVR24)(100.00% vs. 82.67%), end of treatment response (EOT)(100.00% vs. 84%) and early virological response rate (EVR)(92.31% vs. 81.33%) at the end of treatment were higher in the observation group than those in the control group (P<0.05). After treatment, the levels of liver function index[AST(26.10±2.29)U/L vs. (35.02±3.36)U/L; total bilirubin (10.09±1.75)μmol/L vs. (13.20±2.23)μmol/L;ALT(25.04±2.40)U/L vs. (34.21±3.32) U/L] in both groups were decreased (P<0.05), and the downward trend of the observation group is more obvious. (P<0.05). After intervention, the serum concentrations of type III procollagen N-terminal peptide (PC-Ⅲ)[(35.01±3.25) ng/mL vs. (42.38±4.46) ng/mL], hyaluronidase acid (HA)[(84.11±9.13) ng/mL vs. (95.26±11.08) ng/mL] and laminin (LN)[(44.02±4.19) ng/mL vs. (53.65±7.83) ng/mL] demonstrated significant declines in both cohorts, with the observation group showing greater suppression in the biomarkers′ levels (P<0.05). There was no difference in the total incidence of adverse reactions between the two groups (14.10% vs. 10.67%) (χ²=0.415,P=0.519). Conclusion Sofosbuvir/velpatasvir is effective in the treatment of CHC in children and adolescents. It can improve the liver function and alleviate the progression of liver fibrosis, and is safe and reliable.

Key words: Chronic hepatitis C, Direct-acting antivirals, Rapid virological response, Anaemia

杨娟, 朱小艳. 慢性丙型肝炎患者接受DAAs治疗实现快速病毒学应答后代谢、肾脏和血液学变化[J]. 肝脏, 2026, 31(6): 808-811.

Yang Juan, Zhu Xiaoyan. The metabolic, renal and hematological changes in chronic hepatitis C patients after receiving direct antiviral therapy to achieve rapid virological response[J]. Chinese Hepatolgy, 2026, 31(6): 808-811.

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