肝移植术后丙型肝炎复发患者抗病毒治疗效果及其对肝纤维化的影响

周双男; 孙艳玲; 张敏; 刘振文; 高银杰; 向轶; 周霞; 汤汝佳; 贺希; 苏海滨

doi:10.3969/j.issn.1001-5256.2014.01.008

肝移植术后丙型肝炎复发患者抗病毒治疗效果及其对肝纤维化的影响

DOI: 10.3969/j.issn.1001-5256.2014.01.008

解放军第三O二医院肝移植研究中心内科

基金项目:

2011年解放军第302医院院长创新基金(YNKT2011015)；

详细信息

中图分类号: R657.3
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出版历程
- 收稿日期: 2013-09-30
- 出版日期: 2014-01-20

Antiviral therapy for recurrent hepatitis C after liver transplantation and its effect on liver fibrosis

Department of Internal Medicine, Liver Transplantation Center, 302 Hospital of PLA

Research funding:

摘要

摘要:
目的通过对肝移植术后丙型肝炎复发患者进行抗病毒治疗,研究抗病毒治疗效果以及对肝纤维化进展的影响。方法对本院2005年6月至2012年12月收治的23例肝移植术后丙型肝炎复发患者进行干扰素联合利巴韦林抗病毒治疗,观察病毒学应答情况、不良反应以及治疗前后肝组织病理情况。计数资料以例数表示,不同抗病毒疗效组间肝纤维化情况比较采用等级资料秩和检验。结果 12例患者因不良反应终止治疗。23例患者共获得结束时病毒学应答(ETVR)18例,其中6例获得持续病毒学应答(SVR),12例出现反跳。19例患者完成前后肝组织病理检查,SVR组肝纤维化减轻3例、持平1例、进展0例;停药后反跳组肝纤维化减轻2例、持平3例、进展5例;无应答组肝纤维化减轻0例、持平1例、进展4例;3组间抗纤维化效果比较,差异有统计学意义(χ2=7.330,P=0.026)。结论肝移植术后丙型肝炎复发患者抗病毒治疗SVR率较低,有效的抗病毒治疗可延缓肝纤维化进展,取得SVR的患者肝纤维化改善效果最佳。
- 肝移植 /
- 肝炎,丙型 /
- 抗病毒药 /
- 肝硬化
Abstract:
Objective To perform antiviral therapy in patients with recurrent hepatitis C after liver transplantation and to study the efficacy of antiviral therapy and its effect on the progression of liver fibrosis. Methods Twenty- three patients with recurrent hepatitis C after liver transplantation who were admitted to our hospital from June 2005 to December 2012 were treated with interferon plus ribavirin. Virological response, adverse reactions, and liver pathology were observed before and after treatment. Enumeration data were expressed as number of cases and constituent ratio; comparison of anti- fibrotic effect between the groups with different responses to antiviral therapy was made by rank sum test. Results Twelve patients discontinued treatment due to adverse reactions. Eighteen patients achieved end- of- treatment virological response ( ETVR) ; 6 of the 18 patients achieved sustained virological response ( SVR) , and 12 relapsed after treatment. Nineteen patients underwent liver biopsy before and after treatment. In the SVR group, liver fibrosis was improved in 3 cases, stable in 1 case, and worse in 0 case; in the relapse group, liver fibrosis was improved in 2 cases, stable in 3 cases, and worse in 5 cases; in the patients without response, liver fibrosis was improved in 0 case, stable in 1 case, and worse in 4 cases. There were significant differences in anti- fibrotic effect between the three groups ( χ2= 7. 330, P = 0. 026) . Conclusion SVR rate is low in patients who receive antiviral therapy for recurrent hepatitis C after liver transplantation. Effective antiviral therapy can delay the progression of liver fibrosis, and patients with SVR have the most improvement in liver fibrosis.
- liver transplantation /
- hepatitis C /
- antiviral agents /
- liver cirrhosis

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参考文献(16)

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