Outcomes assessment of hepatitis C virus-positive psoriatic patients treated using pegylated interferon in combination with ribavirin compared to new Direct-Acting Antiviral agents

AIM To evaluate the outcomes in biological treatment and quality of life of psoriatic patients with chronic hepatitis C(CHC) treated with new Direct-Acting Antiviral agents(DAAs) compared to pegylated interferon-2α plus ribavirin(P/R) therapy.METHODS This is a retrospective study involving psoriatic patients in biological therapy who underwent anti-hepatitis C virus(HCV) treatment at the Department of Dermatology Galeazzi Orthopaedic Institute Milan, Italy from January 2010 to November 2017. The patients were divided into two groups: patients that underwent therapy with DAAs and patients that underwent HCV treatment with P/R. Patients were assessed by a dermatologist for psoriasis symptoms, collecting Psoriasis Area Severity Index(PASI) scores and the Dermatology Quality of Life Index(DLQI). PASI and DLQI scores were evaluated 24 wk after the end of HCV treatment and were assumed as an outcome of the progression of psoriasis. Switching to a different b DMARD was considered as an inadequate response to biological therapy. The dropout of HCV therapy and sustained virological response(SVR) were considered as outcomes of HCV therapy.RESULTS Fifty-nine psoriatic patients in biological therapy underwent antiviral therapy for CHC. Of this, 27 patients were treated with DAAs and 32 with P/R. After 24 wk post treatment, the DLQI and the PASI scores were significantly lower(P < 0.001 and P < 0.005, respectively) in the DAAs group compared with P/R group. None of the patients in the DAAs group(0/27) compared to 8 patients of the P/R group(8/32) needed a shift in biological treatment.CONCLUSION DAAs seem to be more effective and safe than P/R in HCV-positive psoriatic patients on biological treatment. Fewer dermatological adverse events may be due to interferon-free therapy.

Liver decompensation predicts ribavirin overexposure in hepatitis C virus patients treated with direct-acting antivirals

AIM To determine whether ribavirin(RBV) concentrations differ according to cirrhosis stage among cirrhotic patients treated with interferon-free regimens. METHODS We included patients with hepatitis C virus and cirrhosis [Child-Pugh(CP) A or B], Glomerular Filtration Rate ≥ 60 mL/min, who started therapy with DAAs and weightbased RBV between October 2014 and February 2016. RBV plasma levels were assessed during the treatment. We focused our analysis on the first 8 wk of therapy. RESULTS We studied 68 patients: 54 with compensated(CP-B) and 14 with decompensated(CP-A) cirrhosis. Patients withdecompensated cirrhosis displayed significantly higher RBV concentrations than those with compensated cirrhosis at week 1, 2, 4 and 8(P < 0.035). RBV levels were positively correlated with Hb loss over the treatment(P < 0.04). Majority(71%) of CP-B patients required a RBV dosage reduction during the treatment. After adjustment for confounders, Child-Pugh class remained significantly associated(95%CI: 35, 348, P = 0.017) to RBV levels, independently from baseline per-Kg RBV dosage. CONCLUSION Liver decompensation might affect RBV clearance leading to an overexposure and increased related toxicities in decompensated cirrhosis. Our findings underscore the importance of an early ribavirin therapeutic drug monitoring and suggest that an initial lower RBV dose, rather than weight-based, might be considered in those with advanced liver disease(CP-B) treated with directacting antivirals.

Association between direct-acting antiviral agents in hepatitis C virus treatment and hepatocellular carcinoma occurrence and recurrence:The endless debate

Since direct-acting antiviral agents(DAAs)have been introduced into hepatitis C virus treatment,the sustained viral response(SVR)rate has significantly increased to more than 95%.Scientific evidence supports the idea that SVR after interferon therapy has beneficial effects related to cirrhosis progression,resulting in a reduction in the incidence of hepatocellular carcinoma(HCC).However,a significant debate exists related to DAA impact on HCC development.We reviewed the current literature highlighting the controversial data related to DAA association with de novo HCC occurrence or recurrence and possible pathophysiology of HCC related to DAAs.After a review of the published literature,we believe that the current evidence does not confirm or repudiate a higher rate of de novo HCC occurrence or recurrence related to DAA therapy.More trials are needed to determine if there is an association between HCC occurrence or recurrence and DAA or if it is related to preexisting liver cirrhosis.

Liver injury from direct oral anticoagulants

BACKGROUND Drug-induced liver injury(DILI)can be caused by any prescribed drug and is a significant reason for the withdrawal of newly launched drugs.Direct-acting oral anticoagulants(DOACs)are non-vitamin K-based antagonists recently introduced and increasingly used for various clinical conditions.A meta-analysis of 29 randomised controlled trials and 152116 patients reported no increased risk of DILI with DOACs.However,it is challenging to predict the risk factors for DILI in individual patients with exclusion of patients with pre-existing liver disease from these studies.AIM To determine the risk factors and outcomes of patients who developed DILI secondary to DOACs by systematic review and meta-summary of recent case reports and series.METHODS A systematic search was conducted on multiple databases including PubMed,Science Direct,Reference Citation Analysis,and Google Scholar.The search terms included“Acute Liver Failure”OR“Acute-On-Chronic Liver Failure”OR“Acute Chemical and Drug Induced Liver Injury”OR“Chronic Chemical and Drug Induced Liver Injury”AND“Factor Xa Inhibitors”OR“Dabigatran”OR“Rivaroxaban”OR“apixaban”OR“betrixaban”OR“edoxaban”OR“Otamixaban”.The results were filtered for literature published in English and on adult patients.Only case reports and case studies reporting cases of DILI secondary to DOACs were included.Data on demographics,comorbidities,medication history,laboratory investigations,imaging,histology,management,and outcomes were extracted.RESULTS A total of 15 studies(13 case reports and 2 case series)were included in the analysis,comprising 27 patients who developed DILI secondary to DOACs.Rivaroxaban was the most commonly implicated DOAC(n=20,74.1%).The mean time to onset of DILI was 40.6 d.The most common symptoms were jaundice(n=15,55.6%),malaise(n=9,33.3%),and vomiting(n=9,33.3%).Laboratory investigations showed elevated liver enzymes and bilirubin levels.Imaging studies and liver biopsies revealed features of acute hepatitis and cholestatic injury.Most patients had a favourable outcome,and only 1 patient(3.7%)died due to liver failure.CONCLUSION DOACs are increasingly used for various clinical conditions,and DILI secondary to DOACs is a rare but potentially serious complication.Prompt identification and cessation of the offending drug are crucial for the management of DILI.Most patients with DILI secondary to DOACs have a favourable outcome,but a small proportion may progress to liver failure and death.Further research,including post-marketing population-based studies,is needed to better understand the incidence and risk factors for DILI secondary to DOACs.

HIV/HCV Antiviral Drug Interactions in the Era of Direct-acting Antivirals

Therapy for human immunodeficiency virus (HIV) and chronic hepatitis C has evolved over the past decade,resulting in better control of infection and clinical outcomes;however,drug-drug interactions remain a significant hazard.Joint recommendations from the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America regarding drug-drug interactions between HIV antiretroviral agents and direct-acting antiviral agents for treatment of hepatitis C virus (HCV) infection are reviewed here.This review is oriented to facilitate appropriate selection of an antiviral therapy regimen for HCV infection based on the choice of antiretroviral therapy being administered and,if necessary,switching antiretroviral regimens.

Review of Clinically Relevant Drug Interactions with Next Generation Hepatitis C Direct-acting Antiviral Agents

In this review,we examine the pharmacokinetics and clinically relevant drug interactions of the newer generation direct-acting antivirals(DAAs)for the treatment of chronic hepatitis C,specifically sofosbuvir/velpatasvir(Epclusa®),sofosbuvir/velpatasvir/voxilaprevir(Vosevi®),glecaprevir/pibrentasvir(Maviret®),and elbasvir/grazoprevir(Zepatier®).We searched MEDLINE(1948-January 2020),Embase(1964-January 2020),Google,and GoogleScholar using the terms pharmacokinetics,drug interaction,drug metabolism,sofosbuvir,velpatasvir,Epclusa,voxilaprevir,Vosevi,glecaprevir,pibrentasvir,Maviret,elbasvir,grazoprevir,and Zepatier,from inception to January 13,2020.The search was limited to randomized controlled trials,in vitro studies,prospective and retrospective human studies,drug monographs,abstracts,and conference proceedings.All relevant published literature on pharmacokinetic and pharmacodynamic interactions involving DAAs were reviewed and the data extracted.Numerous clinically relevant drug-drug interactions(DDIs)were identified with the newer generation DAAs and commonly prescribed drugs.NS3/4A protease inhibitors are more likely to be involved in DDIs,followed by NS5A inhibitors and NS5B polymerase inhibitor.The majority of clinically relevant DDIs are predictable,according to known pharmacokinetic,pharmacodynamics,and physicochemical properties of DAAs;however,in select cases,unpredictable DDIs do occur.As expected,many drug interactions exist between newer generation DAAs and commonly prescribed medications.While the majority of clinically relevant interactions are predictable,many require therapeutic dose adjustment or careful selection of non-interacting drugs.In select cases,severe and unpredictable drug interactions can occur.Clinicians should consult hepatitis C virus pharmacotherapy experts and tertiary drug interaction resources when initiating DAA therapy in patients taking other medications.

Can remdesivir and its parent nucleoside GS-441524 be potential oral drugs? An in vitro and in vivo DMPK assessment

Remdesivir(RDV) is the only US Food and Drug Administration(FDA)-approved drug for treating COVID-19.However,RDV can only be given by intravenous route,and there is a pressing medical need for oral antivirals.Significant evidence suggests that the role of the parent nucleoside GS-441524 in the clinical outcomes of RDV could be largely underestimated.We performed an in vitro and in vivo drug metabolism and pharmacokinetics(DMPK) assessment to examine the potential of RDV,and particularly GS-441524,as oral drugs.In our in vitro assessments,RDV exhibited prohibitively low stability in human liver microsomes(HLMs,t1/2=-1 min),with the primary CYP-mediated metabolism being the mono-oxidation likely on the phosphoramidate moiety.This observation is poorly aligned with any potential oral use of RDV,though in the presence of cobicistat,the microsomal stability was drastically boosted to the level observed without enzyme cofactor NADPH.Conversely,GS-441524 showed excellent metabolic stability in human plasma and HLMs.In further in vivo studies in CD-1 mice,GS-441524 displayed a favorable oral bioavailability of 57%.Importantly,GS-441524 produced adequate drug exposure in the mice plasma and lung,and was effectively converted to the active triphosphate,suggesting that it could be a promising oral antiviral drug for treating COVID-19.

喜炎平与双金口服液配伍治疗小儿手足口病200例对照观察

目的:观察双金清热口服液与喜炎平配伍治疗小儿手足口病的临床疗效。方法:将400例普通型手足口病患儿随机分为观察组(200例)和对照组(200例),两组患儿均给予碘甘油口腔护理,适当补液,维持水、电解质平衡及退热剂退热治疗。对照组用喜炎平注射液治疗,观察组用小儿双金清热口服液联合喜炎平注射液治疗,观察两组患儿临床疗效。结果:观察组患儿总有效率为96.5%,高于对照组的80.0%(P<0.05),观察组治愈时间、发热消退时间及疱疹消退时间明显低于对照组(P<0.05)。结论:采用小儿双金清热口服液联合喜炎平治疗小儿普通型手足口病临床疗效显著。

Distribution and changes in hepatitis C virus genotype in China from 2010 to 2020

BACKGROUND Hepatitis C virus(HCV)causes a large number of infections worldwide.New infections seem to be increasing according to a report of the World Health Organization in 2015.Although direct-acting antivirals are quite effective for most genotypes of the HCV,some genotypes fail to respond.Therefore,the trend of genotype distribution is vital to better control the development of this infection.AIM To analyze the distribution and trends of the HCV genotype before and after the emergence of direct-acting antivirals in China.METHODS We searched all literature published in five electronic databases-China National Knowledge Infrastructure,Wan Fang Data,VIP Chinese Journal Database,Chinese Biomedical Literature Service System,and PubMed-from January 1,2010 to December 31,2020.The search strategy combined medical subject headings and free-text terms,including“hepatitis C virus”or“HCV”and“genotype”or“subtype”and“China”or“Chinese”.Additional relevant articles were searched by manual selection.Data were extracted to build a database.All of the data were totaled according to regions,periods,routes of transmission,and sexes.The percentages in various stratifications were calculated.RESULTS There were 76110 samples from 30 provinces included in the study.Genotype 1(G1)accounted for 58.2%of cases nationwide,followed by G2,G6,G3b,G3a,unclassified and mixed infections(17.5%,7.8%,6.4%,4.9%,1.8%,and 1.2%,respectively).The constitution of genotype varied among different regions,with G6 and G3b being more common in the south and southwest,respectively(28.1%,15.4%).The past ten years have witnessed a decrease in G1 and G2 and an increase in G3 and G6 in almost all regions.The drug-use population had the most abundant genotypes,with G6 ranking first(33.3%),followed by G1 and G3b(23.4%,18.5%).CONCLUSION G3 and G6 pose a new challenge for HCV infection.This study revealed the distribution of HCV genotypes in China over the past 10 years,providing information for HCV management strategies.

New hope for hepatitis C virus:Summary of global epidemiologic changes and novel innovations over 20 years

Hepatitis C virus(HCV)is a global health concern associated with significant morbidity and mortality.Before the approval of second-generation direct-acting antiviral agents(DAAs),interferon therapy and liver transplantation constituted the mainstay of treatment.The introduction of well-tolerated oral DAAs in late 2013 has revolutionized HCV management with over 95%cure rates.The predominance of HCV-related liver transplantations has declined following the widespread approval of DAAs.Despite the unparallel efficacy observed among these novel therapies,pharmaceutical costs continue to limit equitable access to healthcare and likely contribute to the differential HCV infection rates observed globally.To reduce the burden of disease worldwide,essential agenda items for all countries must include the prioritization of integrated care models and access to DAAs therapies.Through transparent negotiations with the pharmaceutical industry,the consideration for compassionate release of medications to promote equitable division of care is paramount.Here we provide a literature review of HCV,changes in epidemiologic trends,access issues for current therapies,and global inequities in disease burden.

Outreach onsite treatment with a simplified pangenotypic directacting anti-viral regimen for hepatitis C virus micro-elimination in a prison

BACKGROUND Prisoners are at risk of hepatitis C virus(HCV)infection,especially among the people who inject drugs(PWID).We implemented an outreach strategy in combination with universal mass screening and immediate onsite treatment with a simplified pan-genotypic direct-acting antivirals(DAA)regimen,12 wk of sofosbuvir/velpatasvir,in a PWID-dominant prison in Taiwan.AIM To implement an outreach strategy in combination with universal mass screening and immediate onsite treatment with a simplified pan-genotypic DAA regimen in a PWID-dominant prison in Taiwan.METHODS HCV-viremic patients were recruited for onsite treatment program for HCV micro-elimination with a pangenotypic DAA regimen,12 wk of sofosbuvir/velpatasvir,from two cohorts in Penghu Prison,either identified by mass screen or in outpatient clinics,in September 2019.Another group of HCV-viremic patients identified sporadically in outpatient clinics before mass screening were enrolled as a control group.The primary endpoint was sustained virological response(SVR12,defined as undetectable HCV ribonucleic acid(RNA)12 wk after end-of-treatment).RESULTS A total of 212 HCV-viremic subjects were recruited for HCV micro-elimination campaign;91 patients treated with sofosbuvir/Ledipasvir or glecaprevir/pibrentasvir before mass screening were enrolled as a control.The HCV microelimination group had significantly lower proportion of diabetes,hypertension,hyperlipidemia,advanced fibrosis and chronic kidney diseases,but higher levels of HCV RNA.The SVR12 rate was comparable between the HCV microelimination and control groups,95.8%(203/212)vs 94.5%(86/91),respectively,in intent-to-treat analysis,and 100%(203/203)vs 98.9%(86/87),respectively,in perprotocol analysis.There was no virological failure,treatment discontinuation,and serious adverse event among sofosbuvir/velpatasvir-treated patients in the HCV micro-elimination group.CONCLUSION Outreach mass screening followed by immediate onsite treatment with a simplified pangenotypic DAA regimen,sofosbuvir/velpatasvir,provides successful strategies toward HCV micro-elimination among prisoners.

Monitoring hepatitis C virus treatment rates in an Opioid Treatment Program:A longitudinal study

BACKGROUND Direct-acting antivirals(DAAs)are recommended for the treatment of hepatitis C virus(HCV)infection in patients treated with methadone or buprenorphine.AIM To assess HCV treatment rates in an Opioid Treatment Program(OTP).METHODS This longitudinal study included 501 patients(81.4%men,median age:45 years;interquartile range:39-50 years)enrolled in an OTP between October 2015 and September 2017.Patients were followed until September 2019.Data on sociodemographics,substance use,HCV infection,human immunodeficiency virus(HIV)infection and laboratory parameters were collected at entry.We analyzed medical records to evaluate HCV treatment.Kaplan-Meier methods and Cox regression models were used to analyze the DAA treatment uptake and to identify treatment predictors.RESULTS Prevalence of HCV and HIV infection was 70%and 34%,respectively.Among anti-HCV-positive(n=336)patients,47.2%,41.3%,and 31.9%used alcohol,cannabis,and cocaine,respectively.HCV-RNA tests were positive in 233(69.3%)patients.Twentyeight patients(8.3%)cleared the infection,and 59/308(19.1%)had received interferon-based treatment regimens before 2015.Among 249 patients eligible,111(44.6%)received DAAs.Treatment rates significantly increased over time from 7.8/100 person-years(p-y)(95%CI:5.0-12.3)in 2015 to 18.9/100 p-y(95%CI:11.7-30.3)in 2019.In a multivariate analysis,patients with HIV co-infection were twice as likely to receive DAAs(HR=1.94,95%CI:1.21-3.12)than patients with HCV mono-infection.Current drug use was an independent risk factor for not receiving treatment against infection(HR=0.48,95%CI:0.29-0.80).CONCLUSION HCV treatment is evolving in patients with HCV-HIV co-infection.Ongoing drug use while in an OTP might negatively impact the readiness to treat infection.

乙肝相关性肝癌患者口服抗病毒药物管理

肝癌是乙型肝炎病毒感染后演变的一个重要临床结局,其中抗病毒治疗正是延缓这一过程的关键举措。长效干扰素由于不良反应相对口服抗病毒药物严重及皮下注射的给药途径,致使口服抗病毒治疗在临床上应用更加广泛。但由于需要长期坚持服药,定期复查,监测其耐药性,给患者生活带来一定影响,导致患者服药依从性不佳。影响患者规范用药除了患者自身认知、依从性不足以外,还有很多其他外在因素。越来越多文章指出全面、连续、一体化治疗的重要性。文章为患者、家属、医务人员及社会其他人群呈现影响口服抗病毒药物管理的多方面原因,改善口服抗病毒药物的管理。

基于索非布韦的口服直接作用抗病毒药物治疗终末期肾病合并丙型肝炎病毒感染的血液透析患者的疗效与安全性研究

目的分析基于索非布韦的口服直接作用抗病毒药物治疗终末期肾病合并丙型肝炎病毒感染的血液透析患者的疗效以及安全性。方法选择2018年5月—2020年2月于山东省济南市中心医院进行治疗的终末期肾病合并丙型肝炎病毒感染的血液透析患者6例,所有患者均服用索非布韦与达拉他韦进行治疗,6例患者中,失代偿期肝硬化的有1例,代偿期肝硬化为1例,慢性丙型肝炎4例,其中失代偿期肝硬化患者需治疗24周,其他患者治疗12周。观察所有患者的治疗有效性以及安全性。结果随访结果显示,6例患者都获得了快速病毒学应答,没有病毒学突破,也不存在终末期肾病合并丙型肝炎病毒感染的情况。口服直接作用抗病毒药物治疗过程中,6例患者血小板、尿素清除指数、白细胞、尿素下降率以及血红蛋白和治疗之前无差异,肝功能正常。经治疗,只有1例患者发生不良反应,不良反应发生的几率为16.67%。该例患者的不良反应未经过特殊处理便自行好转。结论对终末期肾病合并丙型肝炎病毒感染的血液透析患者采用索非布韦与达拉他韦进行治疗,治疗效果和安全性极好,可在临床推广使用。

Factors influencing the failure of interferon-free therapy for chronic hepatitis C:Data from the Polish EpiTer-2 cohort study

BACKGROUND The introduction of direct-acting antiviral drugs into clinical practice has revolutionized the treatment of chronic hepatitis C,making it highly effective and safe for patients.However,few researchers have analyzed the factors causing therapy failure in some patients.AIM To analyze factors influencing the failure of direct antiviral drugs in the large,multicenter EpiTer-2 cohort in a real-world setting.METHODS The study cohort consisted of patients with chronic hepatitis C treated at 22 Polish centers from 2016-2020.Data collected from the online EpiTer-2 database included the following:hepatitis C virus(HCV)genotype,stage of fibrosis,hematology and liver function parameters,Child-Turcotte-Pugh and Model for End-stage Liver Disease scores,prior antiviral therapy,concomitant diseases,and drugs used in relation to hepatitis B virus(HBV)and/or human immunodeficiency virus(HIV)coinfections.Adverse events observed during the treatment and follow-up period were reported.Both standard and machine learning methods were used for statistical analysis.RESULTS During analysis,12614 patients with chronic hepatitis C were registered,of which 11938(mean age:52 years)had available sustained virologic response(SVR)data[11629(97%)achieved SVR and 309(3%)did not].Most patients(78.1%)were infected with HCV genotype 1b.Liver cirrhosis was diagnosed in 2974 patients,while advanced fibrosis(F3)was diagnosed in 1717 patients.We included patients with features of hepatic failure at baseline[ascites in 142(1.2%)and encephalopathy in 68(0.6%)patients].The most important host factors negatively influencing treatment efficacy were liver cirrhosis,clinical and laboratory features of liver failure,history of hepatocellular carcinoma,and higher body mass index.Among viral factors,genotype 3 and viral load also exerted an influence on treatment efficacy.Classical statistical analysis revealed that treatment ineffectiveness seemed to be influenced by the male sex,which was not confirmed by the multivariate analysis using the machine learning algorithm(random forest).Coinfection with HBV(including patients with on-treatment reactivation of HBV infection)or HIV,extrahepatic manifestations,and renal failure did not significantly affect the treatment efficacy.CONCLUSION In patients with advanced liver disease,individualized therapy(testing for resistance-associated variants and response-guided treatment)should be considered to maximize the chance of achieving SVR.

干扰素联合口服抗病毒药物治疗中国人生殖器疱疹的荟萃分析

目的对中国地区干扰素联合口服抗病毒药物治疗生殖器疱疹的安全性和有效性进行荟萃分析。方法分别在中国知网、万方数据库和维普中文数据库和PubMed、EMbase外文数据库上检索所有干扰素联合口服抗病毒药物治疗生殖器疱疹的随机对照试验,以临床治疗总有效率、平均治愈时间、复发率、不良反应发生率和类型作为结局指标,评价其有效性和安全性。采用Cochrane手册的标准评价纳入研究的质量,对有足够相似性的资料使用RevMan5.3软件进行荟萃分析,根据不同干预措施进行敏感度分析和发表偏移分析。结果共纳入16篇中文文献合计1 515例生殖器疱疹患者。荟萃分析表示,干扰素联合口服抗病毒药物治疗组在平均治愈时间(MD=-2.155, 95%CI:-3.04~-1.26,P<0.01)和复发率(RR=0.50, 95%CI:0.43~0.59,P<0.01)方面较单独使用口服抗病毒药物有优势。实验组与对照组之间,总有效率(RR=1.15, 95%CI:0.93~1.42,P>0.05)及不良反应发生率(RR=0.59, 95%CI:0.32~1.12,P=0.11)方面没有明显的差异。两组患者的不良反应均较少见,并且较轻微,可通过对症治疗改善或自行缓解。结论与单纯使用口服抗病毒药物相比,干扰素联合口服抗病毒药物治疗生殖器疱疹可以有效缩短疗程、减少复发,且安全性好。

长期口服抗肿瘤靶向药物患者合并使用抗新型冠状病毒药物的药学监护

《新型冠状病毒肺炎诊疗方案(试行第七版)》延续第六版,推荐5种抗新型冠状病毒(SARS-CoV-2)的药物,同时强调药物毒性反应、相互作用的警示,关注特殊患者群抗病毒药物的选择。肿瘤患者是具有高感染率、高死亡率的特殊患者群,选择抗病毒药物应慎重,以期获得高效低毒的治疗效果。本文根据小分子口服肿瘤靶向药物的临床应用与毒性特点,结合肿瘤患者病理、生理特征,参考抗病毒药物临床及基础研究的相关文献数据,对长期口服靶向药物肿瘤患者的抗病毒药物选择进行了分析与探讨。以期为临床肿瘤患者抗病毒药物的选择提供参考。

地芪固本口服液对慢性丙型病毒性肝炎抗病毒治疗不良反应的影响研究

目的:探讨地芪固本口服液对慢性丙型病毒性肝炎(CHC)患者抗病毒治疗中不良反应(ADR)的影响。方法:参照2004年《丙型肝炎防治指南》诊断标准,将189例CHC患者随机分为2组,治疗组95例,对照组94例。两组均给予聚乙二醇干扰素α-2a 180μg,1周1次,皮下注射和按体重口服利巴韦林1000 mg·d^(-1)(体重<75 kg)或1200 mg·d^(-1)(体重>75 kg),疗程48周,治疗结束后随访24周。治疗组加用地芪固本口服液,一次50 m L,一日2次。监测两组患者治疗期间ADR发生情况。结果:治疗组共发生ADR 701例次,对照组发生894例次。从整体看,发生了至少一次ADR的患者及人均发生例次数两组差异有统计学意义(P≤0.05)。在疲乏、白细胞减少、中性粒细胞减少、体重减低、血小板减少、贫血、精神异常发生率上,两组差异具有统计学意义(P≤0.05),治疗组均低于对照组。两组ADR的严重程度均以1级和2级为主,两组严重程度的百分率经秩和检验Z=8.030,P<0.05,差异有统计学意义。治疗组SDS评分均低于对照组,尤其是治疗12、24周(P≤0.05)。结论:地芪固本口服液能够有效减少和减轻抗病毒治疗引起的ADR。

口服小分子抗新型冠状病毒药物的研究进展

新型冠状病毒肺炎是由严重急性呼吸道综合征冠状病毒2引起的急性呼吸道传染病,是近百年来人类遭遇的影响范围最广的全球性大流行疾病。抗病毒药物是治疗新型冠状病毒感染的首选。口服小分子抗新型冠状病毒药物使用方便,且适用于轻中症患者。目前小分子抗新型冠状病毒药物有血管紧张素转换酶2(ACE2)抑制剂、膜融合抑制剂、RNA聚合酶抑制剂和3CL蛋白酶抑制剂。归纳了口服小分子抗新型冠状病毒药物的研究进展,为口服小分子抗新型冠状病毒药物的研发提供思路。

直接进样石墨炉原子吸收测定双黄连口服液中铅的含量

目的:建立直接进样石墨炉原子吸收法测定双黄连口服液中Pb含量的测量方法。方法:用浓度为0.15 mol·L-1HNO3将双黄连口服液稀释5倍,以十二烷基硫酸钠作为基体改进剂,选择灰化温度600℃,原子化温度1800℃,氩气作为保护气体,利用石墨炉原子吸收法测定Pb的含量。结果:在优化条件下测定Pb的加标回收率为98.2%～102.7%,精密度(RSD)≤2.67%,检出限为3.16 ng·mL-1。结论:直接进样石墨炉原子吸收法测定双黄连口服液中Pb的含量,不需要进行样品的复杂处理,方法快速、准确、无污染。