应用索磷布韦/维帕他韦治疗门诊和住院筛查的丙型肝炎患者疗效研究

Short-term efficacy of sofosbuvir and velpatasvir in the treatment of patients with hepatitis C

目的调查真实世界丙型肝炎病毒感染情况,并探讨应用索磷布韦/维帕他韦治疗慢性丙型肝炎(CHC)患者病毒学应答情况。方法2017年9月~2019年9月行血清抗-HCV检测的3966例住院和门诊患者,应用索磷布韦/维帕他韦治疗CHC患者12 w。结果在3966例患者中,检出血清抗-HCV阳性80例(2.0%);在80例抗-HCV阳性者中,同期进行了血清HCV RNA检测者42例,结果40例(95.2%)血清HCV RNA阳性;在40例CHC患者中,12例无明显症状和体征,18例有腹胀、乏力、纳差,10例有蜘蛛痣、肝病面容、肝掌、脾肿大;35例血清AST>90 U/L,4例AST轻度异常,1例AST正常;3例存在HBV/HCV混合感染;B超检查14例正常,26例提示肝内光点增粗;40例CHC患者接受索磷布韦/维帕他韦治疗,结果RVR、EVR、ETVR、SVR、NR和复发率分别为75.0%、80.0%、82.5%、72.5%、10.0%和10.0%;在治疗12 w末,血清TBIL水平为(30.7±4.3)μmol/L,显著低于治疗前【(80.4±15.6)μmol/L,P<0.05】,血清AST水平为(72.5±18.6)U/L,显著低于治疗前【(247.7±110.4)U/L,P<0.05】,血清ALB水平为(49.2±11.5)g/L,显著高于治疗前【(35.9±9.2)g/L,P<0.05】;不良反应发生率为22.5%。结论真实世界丙型肝炎发病率较高,对患者进行HCV感染筛查很有必要。应用索磷布韦/维帕他韦治疗CHC患者疗效显著,血清病毒学应答率高,能显著改善肝功能,且具有一定的安全性。

Objective The aim of this study was to investigate the screening of patients with hepatitis C in the real world,and the efficacy of sofosbuvir and velpatasvir in patients with hepatitis C.Methods Serum anti-HCV screening was carried out in 3966 inpatients and outpatients in our hospital between September 2017 and September 2019,and the confirmed patients with chronic hepatitis C(CHC)received sofosbuvir and velpatasvir treatment for 12 weeks.Results Among the 3966 patients screened,serum anti-HCV positive was 2.0%(80/3966),and out of the 80 patients with anti-HCV positive,42 cases had their serum HCV RNA loads tested and 40 cases(95.2%)were positive;in the 40 patients with CHC,there were 12 cases without any obvious symptoms and signs,18 cases had abdominal distension,fatigue and anorexia,10 cases had vascular spider,liver disease face,liver palms,and splenomegaly;there were 35 cases having serum AST level>90 U/L,4 cases having mildly elevated serum AST level and 1 case having normal serum AST level;3 cases had mixed HBV/HCV infection;the B-mode ultrasound examination showed normal liver in 14 cases,and increased intrahepatic light spots in 26 cases;in 40 patients with CHC treated with sofosbuvir and velpatasvir,the early virologic response,rapid virologic response,the end treatment virologic response,sustained virologic response,none response and recurrence rates were 75.0%,80.0%,82.5%,72.5%,10.0%and 10.0%,respectively;serum bilirubin level in patient after 12 weeks of treatment was(30.7±4.3)μmol/L,significantly lower than[(80.4±15.6)μmol/L,P<0.05]before treatment,and serum AST level was(72.5±18.6)U/L,significantly lower than[(247.7±110.4)U/L,P<0.05]before treatment;serum albumin level was(49.2±11.5)g/L,significantly higher than[(35.9±9.2)g/L,P<0.05]before treatment;the incidence of adverse reactions was 22.5%in our series.Conclusion The prevalence of hepatitis C in the real world is relatively high,and the screening of infection is of great importance.The application of sofosbuvir and velpatasvir in the treatment of patients with hepatitis C has a promising clinical efficacy,with a good serum virological response and safety.