直接抗病毒药物联合利巴韦林对老年基因1b型慢性丙型肝炎代偿期肝硬化患者疗效及安全性分析

Analysis of the efficacy and safety of direct antiviral drugs combined with ribavirin in elderly patients with compensated liver cirrhosis caused by genotype 1b chronic hepatitis C

目的评估直接抗病毒药物联合利巴韦林对老年基因1b型慢性丙型肝炎代偿期肝硬化患者的疗效及安全性。方法选取我院2021年4月—2022年4月安康市中医医院收治的老年基因1b型慢性丙型肝炎代偿期肝硬化患者120例,给予直接抗病毒药物联合利巴韦林干预,观察患者丙型肝炎病毒(HCV)RNA转阴率、病毒学应答情况、肝功能指标及不良反应,探讨直接抗病毒药物联合利巴韦林的疗效及安全性。结果HCV RNA转阴率(66.7%、82.5%、93.3%)随着治疗时间的延长而逐渐升高(P<0.05)。随着治疗结束时间的延长,持续病毒学反应获得率(93.3%、89.2%、86.7%)逐渐降低,但差异无统计学意义(P>0.05)。相较于治疗前的总胆红素(TBil)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)水平[(21.6±3.2)μmol/L、(128.7±14.6)U/L、(83.6±9.3)U/L],治疗后均明显降低[(17.1±2.4)μmol/L、(34.2±5.8)U/L、(26.4±4.7)U/L](P<0.05)。部分患者治疗期间伴有不良反应,头晕乏力者10例,占比为8.3%;血压异常、血糖升高者各5例,占比为4.2%;胃肠道反应者4例,占比为3.3%,上述不良反应经对症治疗后全部恢复正常,患者均可耐受。结论老年基因1b型慢性丙型肝炎代偿期肝硬化患者应用直接抗病毒药物联合利巴韦林治疗具有良好疗效,能够促进HCV RNA转阴,获得持续病毒学反应,并改善肝功能指标水平,临床应用安全性较高。

Objective To evaluate the efficacy and safety of direct-acting antiviral drugs in combination with ribavirin in elderly patients with compensated liver cirrhosis caused by genotype 1b chronic hepatitis C.Methods From April 2021 to April 2022,a total of 120 elderly patients with compensated cirrhosis caused by genotype 1b chronic hepatitis C were treated with a combination of direct-acting antiviral drug and ribavirin in our hospital.We evaluated the seroconversion rate of hepatitis C virus(HCV)RNA,virology response,liver function indicators,and adverse reactions to assess the efficacy and safety of this treatment regimen.Results The seroconversion rate of HCV RNA(66.7%,82.5%,93.3%)showed a progressive increase with the duration of treatment time(P<0.05).As the treatment period extended,the sustained virological response rate(93.3%,89.2%,86.7%)gradually decreased,but the difference was not statistically significant(P>0.05).Compared to the pre-treatment levels of total bilirubin(TBil),alanine transaminase(ALT),and aspartate transaminase(AST)[(21.6±3.2)μmol/L,(128.7±14.6)U/L,(83.6±9.3)U/L],the levels were significantly decreased after treatment[(17.1±2.4)μmol/L,(34.2±5.8)U/L,(26.4±4.7)U/L](P<0.05).During the course of treatment,some patients experienced adverse reactions,including 10 cases of dizziness and fatigue,(8.3%),5 cases of abnormal blood pressure(4.2%),5 cases of elevated blood sugar(4.2%),and 4 cases of gastrointestinal reactions(3.3%).All of these adverse reactions resolved after symptomatic treatment,and the patients were able to tolerate them.Conclusion The use of direct antiviral drugs combined with ribavirin in the treatment of elderly patients with compensated liver cirrhosis caused by genotype 1b chronic hepatitis C has demonstrated good efficacy.It has been shown to promote the seroconversion of HCV RNA,achieve sustained virological response,and improve the level of liver function indicators.Furthermore,this treatment regimen has a high level of clinical safety.