摘要
目的观察应用直接抗病毒药物(DAAs)治疗慢性丙型肝炎(CHC)和丙型肝炎肝硬化(LC)患者疗效及血清血小板生成素(TPO)和外周血血小板(PLT)计数的变化。方法2019年2月~2022年6月我院诊治的CHC患者69例,丙型肝炎LC患者23例和LC并发血小板减少症(TP)患者68例,给予所有患者索磷布韦/维帕他韦片连续治疗12 w,随访24 w。采用ELISA法检测血清TPO水平。结果LC并发TP组外周血白细胞计数、血小板计数和血清白蛋白水平分别为(5.0±1.3)×10^(9)/L、(67.2±13.5)×10^(9)/L和(32.9±1.4)g/L,显著低于CHB组【分别为(8.2±1.0)×10^(9)/L、(182.8±32.7)×10^(9)/L和(39.7±1.8)g/L,P<0.05】或LC组【分别为(7.5±1.2)×10^(9)/L、(145.5±27.6)×10^(9)/L和(35.7±1.5)g/L,P<0.05】,而血清总胆红素和INR分别为(29.5±6.3)μmol/L和(1.4±0.3),显著大于CHC组【分别为(17.1±5.9)μmol/L和(1.0±0.2),P<0.05】;LC并发TP组早期病毒学应答率、治疗结束病毒学应答率和持续病毒学应答率分别为60.3%、70.6%和66.2%,显著低于CHC组的87.0%、100%和97.1%(P<0.05)或LC组的73.9%、82.6%和82.6%(P<0.05);在治疗结束时,LC和LC并发TP组血清TPO水平均显著升高【分别为(68.3±15.0)pg/ml对(42.5±17.6)pg/ml,P<0.05】和【(52.8±16.7)pg/ml对(37.2±13.5)pg/ml,P<0.05】,而外周血血小板计数也同步升高【分别为(184.9±33.8)×10^(9)/L对(145.5±27.6)×10^(9)/L,P<0.05】和【(101.0±26.3)×10^(9)/L对(67.2±13.5)×10^(9)/L,P<0.05】。结论应用DAAs治疗LC和LC并发TP患者在获得抗病毒疗效的同时,还能升高血小板计数,可能与改善了病情并升高血清TPO水平有关,值得进一步研究。
Objective This clinical trial was conducted to investigate serum thrombopoietin(TPO)level and blood platelet count changes in patients with hepatitis C-induced liver cirrhosis(LC)receiving direct-acting antiviral agent(DAA)treatment.Method 69 patients with chronic hepatitis C(CHC),23 patients with hepatitis C-induced LC and 68 patients with hepatitis C-induced LC and complicated thrombocytopenia(TP)were enrolled in this study between February 2019 and June 2022,and all were treated with sophobuvir/vipatavir for 12 weeks.After discontinuation of the regimen,all patients were followed-up for 24 weeks.Serum TPO levels were assayed by ELISA.Results The white blood cell count,platelet count and serum albumin level in patients with LC and TP were(5.0±1.3)×10^(9)/L,(67.2±13.5)×10^(9)/L and(32.9±1.4)g/L,all significantly lower than[(8.2±1.0)×10^(9)/L,(182.8±32.7)×10^(9)/L and(39.7±1.8)g/L,respectively,P<0.05]in patients with CHC or[(7.5±1.2)×10^(9)/L,(145.5±27.6)×10^(9)/L and(35.7±1.5)g/L,respectively P<0.05]in patients with LC,while total serum bilirubin level and international normalization rate of prothrombin time were(29.5±6.3)μmol/L and(1.4±0.3),both much greater than[(17.1±5.9)μmol/L and(1.0±0.2),P<0.05]in patients with CHC;the early virological response,end-oftreatment response and sustained virological response in patients with LC and TP were 60.3%,70.6%and 66.2%,all significantly lower than 87.0%,100%and 97.1%(P<0.05)in patients with CHC or 73.9%,82.6%and 82.6%(P<0.05)in patients with LC;at the end of the antiviral regimen,serum TPO levels in patients with LC and LC with complicated TP increased greatly[(68.3±15.0)pg/ml vs.(42.5±17.6)pg/ml,P<0.05]and[(52.8±16.7)pg/mlvs.(37.2±13.5)pg/ml,P<0.05],and peripheral blood platelet counts increased simultaneously[(184.9±33.8)×10^(9)/L vs.(145.5±27.6)×10^(9)/L,P<0.05]and[(101.0±26.3)×10^(9)/L vs.(67.2±13.5)×10^(9)/L,respectively,P<0.05].Conclusion The DAA treatment could improve thrombocytopenia besides antiviral efficacy,which might be related to the elevated serum TPO levels in patients with hepatitis C-induced LC,and warrants further clinical investigation.
作者
昝双江
于恬
戴静
Zan Shuangjiang;Yu Tian;Dai Jing(Department of Pharmacy,Fourth Central Hospital Affiliated to Nankai University,Tianjin300140,China)
出处
《实用肝脏病杂志》
CAS
2024年第5期757-760,共4页
Journal of Practical Hepatology
基金
天津市自然科学基金自助项目(编号:18JCZDJC36500)。