直接抗病毒药物治疗肝移植术后HCV感染复发的有效性和安全性分析

Efficacy and safety of direct antiviral agents in the treatment of HCV recurrence after liver transplantation

目的 评估直接抗病毒药物(direct antivirus agent, DAA)治疗肝移植术后HCV感染复发的有效性和安全性。方法 回顾性分析首都医科大学附属北京佑安医院2011年2月—2018年12月收治的14例肝移植术后HCV感染复发患者的DAA治疗临床数据,比较患者基线与治疗结束后肝肾功能、血常规、凝血功能、病毒学水平以及无创纤维化评分天冬氨酸转氨酶血小板比率指数(aspartate aminotransferase-platelet ratio index, APRI)的差异。利用电子病历系统和电话随访收集患者治疗期间不良反应发生情况。结果 所有患者均在治疗结束时达到病毒学清除,12周、24周持续病毒学应答率均为100%,DAA治疗后随访17~44个月,期间均未见病毒学复发。与基线水平相比,治疗终点时ALT、AST、TBIL、γ-谷氨酰转移酶以及无创纤维化评分APRI显著下降,WBC、HGB、PLT、CRE、肾小球滤过率和血糖等指标均未见显著变化。DAA治疗期间共3例患者发生不良反应,均为轻度,可自然缓解。结论 肝移植术后HCV感染复发的DAA治疗是安全有效的。

Objective To evaluate the efficacy and safety of direct antiviral agents(DAA) in patients with HCV recurrence after liver transplantation. Methods The clinical data of 14 patients with HCV recurrence after liver transplantation treated with DAAs in Beijing Youan Hospital, Capital Medical University from February 2011 to December 2018 were retrospectively analyzed. The differences of liver function, renal function, complete blood count, coagulation level, virology level and noninvasive fibrosis score, APRI,between baseline and end of treatment(EOT) were compared. Adverse reaction data was collected by electronic medical record system and/or telephone follow-up. Results Virological clearance were achieved in 14 patients at the EOT, and the sustained virological response rates at 12 weeks and 24 weeks were 100% respectively. There was no virological recurrence during the follow-up period.Comparing with the baseline, ALT, AST, TBIL, γ-glutamyl transpeptadase and APRI decreased significantly at the EOT, while WBC,HGB, PLT, CRE, glomerular filtration rate(GFR) and blood glucose had no significant differences. Adverse reactions were observed in 3patients during DAA treatment, which were mild and could be relieved naturally. Conclusions DAA treatment for patients with HCV recurrence after liver transplantation is safe and effective.