直接抗病毒药物治疗HCV相关肝硬化的效果及安全性

Research advances in direct-acting antiviral agents in the treatment of hepatitis C virus-related liver cirrhosis

肝硬化在临床上十分常见,也是包括慢性HCV感染在内的多种慢性肝病的共同临床结局。在直接抗病毒药物(DAA)出现前,基于PEG-IFN及利巴韦林(RBV)的抗HCV治疗常由于肝硬化的存在而疗效不佳,甚至失代偿期肝硬化本身即是应用PEG-IFN治疗的绝对禁忌证。DAAs已逐渐成为临床治疗HCV感染的一线药物,大量研究显示DAAs用于HCV相关肝硬化患者的治疗具有良好的疗效及耐受度。一方面,DAAs治疗代偿期肝硬化患者的疗效及安全性均要优于PEG-IFN/RBV;另一方面,肝硬化失代偿患者也可耐受DAAs治疗,虽然获得的持续病毒学应答比例可能较普通患者更低,但是DAAs仍能使肝硬化失代偿患者在多方面获益。综述了DAAs用于治疗HCV相关肝硬化患者的最新研究,以求为临床诊治提供参考。

Liver cirrhosis is common in clinical practice and is the common clinical outcome of various chronic liver diseases including chronic hepatitis C virus( HCV) infection. Before the development of direct-acting antiviral agents( DAAs),anti-HCV therapy based on pegylated interferon( PEG-IFN.) and ribavirin( RBV) has a poor clinical effect due to the presence of liver cirrhosis,and decompensated liver cirrhosis itself is an absolute contraindication for PEG-IFN treatment. DAAs have gradually become the first-line drug for HCV infection,and many studies have shown that DAAs have good clinical effects and tolerability in the treatment of cirrhotic patients with HCV infection. On the one hand,DAAs have better clinical effect and safety than PEG-IFN/RBV in patients with compensated liver cirrhosis; on the other hand,patients with decompensated liver cirrhosis are tolerant to DAAs,and although they have a lower proportion of patients with sustained virologic response than normal patients,they can still benefit from DAAs from many aspects. This article reviews the latest research advances in DAAs in patients with HCV-related liver cirrhosis,in order to provide a reference for clinical diagnosis and treatment.