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直接抗病毒药物治疗慢性丙型肝炎的效果及对肝硬度、APRI的影响
Efficacy of direct-acting antiviral agents in treatment of chronic hepatitis C and its effect on liver stiffness and aspartate aminotransferase-to-platelet ratio index
文章发布日期:2020年06月01日  来源:  作者:梁静,张亚苹,刘芳,等  点击次数:219次  下载次数:34次

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【摘要】:目的 探讨目前直接抗病毒药物(DAA)治疗方案下,慢性丙型肝炎患者真实世界病毒应答情况及对肝硬度值和天门冬氨酸/血小板比值指数(APRI)的影响。方法 连续性纳入2018年4月1日-2018年11月30日在天津市第三中心医院接受DAA治疗的慢性丙型肝炎患者,应用无干扰素方案的DAA治疗12~24周,评估治疗结束后第12周病毒学应答情况,对比基线及治疗结束后12周肝硬度值和APRI的变化。计量资料两组间比较采用Wilcoxon秩和检验。结果 共纳入212例慢性丙型肝炎患者,其中肝硬化患者占35.4%,基因1b、2a、3a、6a型分别占75.0%、18.4%、4.2%及2.4%。174例患者完成了DAA治疗疗程及治疗后12周随访。在DAA治疗结束和治疗结束后12周获得持续病毒学应答(SVR)的比例分别为98.3%及95.4%。基因1b型、2a型、3a型及6a型患者的SVR12分别为96.3%、93.1%、80.0%及100%。治疗结束后12周肝硬度值较基线[9.8(6.9~16.3) kPa vs 11.4(7.7~19.1) kPa,Z=-2.5,P=0.012]及APRI[0.34(0.25~0.64) vs 0.76(0.56~2.25),Z=-6.6,P<0.001]均明显下降。根据基线是否存在肝硬化进行分组,结果显示治疗结束12周非肝硬化组患者肝硬度值较基线显著降低[7.6(6.6~10.7) kPa vs 8.8(7.2~13.0) kPa,Z=-2.7,P=0.007];而肝硬化组患者治疗前后肝硬度值无明显差异[17.4(12.7~22.1) kPa vs 19.8(12.8~24.9) kPa,Z=-1.4,P=0.152]。肝硬化组和非肝硬化组患者APRI在治疗后12周较基线均明显下降[0.73(0.52~1.34) vs 1.37(0.80~2.11),Z=-3.4,P<0.001;0.29(0.21~0.36) vs 0.54(0.31~0.95),Z=-6.8,P<0.001]。结论 在该真实世界研究中,应用DAA治疗的慢性丙型肝炎患者总体病毒学应答率较高,治疗结束后12周肝硬度及APRI明显改善。
【Abstract】:Objective To investigate the real-world viral response of chronic hepatitis C (CHC) patients receiving direct-acting antiviral agent (DAA) treatment and its effect on liver stiffness measurement (LSM) and aspartate aminotransferase-to-platelet ratio index (APRI). Methods The CHC patients who were consecutively admitted to Tianjin Third Central Hospital from April 1, 2018 to November 30, 2018 and received DAA treatment were enrolled, and all patients were treated with DAA (without interferon) for 12-24 weeks. Virologic response was evaluated at week 12 after treatment ended, and the changes of LSM and APRI from baseline to week 12 after treatment were compared. The Wilcoxon rank-sum test was used for comparison of continuous data between two groups. ResultsA total of 212 CHC patients were enrolled in our study, among whom 35.4% had liver cirrhosis, and the patients with genotype 1b, 2a, 3a, or 6a accounted for 75.0%, 18.4%, 4.2%, and 2.4%, respectively. Of all patients, 174 completed the course of DAA treatment and the 12-week follow-up, and among these patients, 98.3% achieved sustained virologic response (SVR) at the end of DAA treatment and 95.4% acquired SVR at week 12 after the treatment ended. Among the patients with genotype 1b, 2a, 3a, or 6a, 96.3%, 93.1%, 80.0%, and 100%, respectively, achieved SVR at week 12 after the treatment ended. There were significant reductions in LSM [9.8 (6.9-16.3) kPa vs 11.4(7.7-19.1) kPa, Z=-2.5, P=0.012] and APRI [0.34 (0.25-0.64) vs 0.76 (0.56-2.25), Z=-6.6, P<0.001] from baseline to week 12 after the treatment ended. The patients were divided into groups according to the presence or absence of liver cirrhosis at baseline, and the results showed that from baseline to week 12 after treatment ended, the non-liver cirrhosis group had a significant reduction in LSM [7.6 (6.6-10.7) kPa vs 8.8 (7.2-13.0) kPa, Z=-2.7, P=0.007], while the liver cirrhosis group had no significant change in LSM [17.4 (12.7-22.1) kPa vs 19.8 (12.8-24.9) kPa, Z=-1.4, P=0.152]. There was a significant reduction in APRI from baseline to week 12 after treatment ended in the liver cirrhosis group [0.73 (0.52-1.34) vs 1.37 (0.80-2.11), Z=-3.4, P<0.001] and the non-liver cirrhosis group [0.29 (0.21-0.36) vs 0.54 (0.31-0.95), Z=-6.8, P<0.001]. Conclusion In this real-world study, CHC patients treated with DAA achieve a high overall virological response rate, with significant improvements in LSM and APRI at week 12 after treatment ends.
【关键字】:丙型肝炎,慢性; 抗病毒药; 持续病毒学应答; 治疗结果
【Key words】:hepatitis C,chronic; antiviral agents; sustained virologic response; treatment outcome
【引证本文】:LIANG J, ZHANG YP, LIU F, et al. Efficacy of direct-acting antiviral agents in treatment of chronic hepatitis C and its effect on liver stiffness and aspartate aminotransferase-to-platelet ratio index[J]. J Clin Hepatol, 2020, 36(6): 1263-1267. (in Chinese)
梁静, 张亚苹, 刘芳, 等. 直接抗病毒药物治疗慢性丙型肝炎的效果及对肝硬度、APRI的影响[J]. 临床肝胆病杂志, 2020, 36(6): 1263-1267.

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