Clinical efficacy of direct-acting antiviral agents in treatment of patients with hepatitis C recurrence after liver transplantation
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摘要:
目的观察直接抗病毒药物(DAA)治疗肝移植术后丙型肝炎复发患者的安全性和临床疗效。方法收集2014年12月-2015年5月解放军第302医院行肝移植患者15例,术后HCV RNA阳性经治患者采用DAA治疗,1b型采用Harvoni(sofosbuvir400 mg/d+ledipasvir 90 mg/d)或sofosbuvir 400 mg/d+daclatasvir 60 mg/d治疗,2a型采用sofosbuvir 400 mg/d+利巴韦林900 mg/d治疗,疗程12周,定期观察其临床症状和体征变化以及血常规、肝功能和HCV RNA定量等实验室指标情况。结果 15例肝移植术后丙型肝炎复发患者中14例HCV RNA均于14周内阴转,最快5 d阴转,1例患者4周时HCV RNA载量5.6×10 IU/ml。治疗12周时,15例患者HCV RNA全部阴转,治疗结束时病毒学应答获得率为100%。14例目前达到12周持续病毒学应答,其余患者在随访中。3例达到24周持续病毒学应答,其余12例患者在随访中。治疗副反应主要为头痛1例,乏力5例,关节痛1例。结论 DAA治...
Abstract:Objective To observe the clinical effect and safety of direct- acting antiviral agents( DAAs) in patients with hepatitis C recurrence after liver transplantation. Methods Fifteen patients who received liver transplantation in 302 Hospital of PLA from December 2014 to May 2015 were selected,and after treatment,the HCV RNA- positive patients were treated with DAAs. The patients with genotype 1b were treated with Harvoni( sofosbuvir 400 mg / d + ledipasvir 90 mg / d) or sofosbuvir 400 mg / d + daclatasvir 60 mg / d,and those with genotype 2a were treated with sofosbuvir 400 mg / d + ribavirin 900 mg / d. The course of treatment was 12 weeks. The changes in clinical symptoms and signs and laboratory markers including routine blood test,liver function,and HCV RNA quantification were observed regularly. Results Among the 15 patients with hepatitis C recurrence after liver transplantation,14 achieved HCV RNA clearance within 1- 4weeks,and the shortest time to clearance was 5 days; one patient had a HCV RNA level of 5. 6 × 10 IU / ml at week 4. At month 12 of treatment,all the patients achieved HCV RNA clearance,and at the end of treatment,all the patients achieved virologic response. At present,14 patients had achieved sustained virologic response for 12 weeks,and the other patients were still in the follow- up stage; at present,3patients had achieved sustained virologic response for 24 weeks,and the other 12 patients were still in the follow- up stage. Side effects of the treatment were mainly headache( 1 case),weakness( 5 cases),and arthralgia( 1 case). Conclusion DAAs can be used in the treatment of patients with hepatitis C recurrence after liver transplantation with minor side effects,tolerance,and definite curative effect. Long-term sustained virologic response requires further observation.
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Key words:
- hepatitis C /
- liver transplantation /
- antiviral agents /
- therapy
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