丙型肝炎各级肝硬化患者的抗病毒治疗策略

张颖; 魏欣; 贾战生

丙型肝炎各级肝硬化患者的抗病毒治疗策略

第四军医大学唐都医院全军感染病诊疗中心

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中图分类号: R512.63
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出版历程
- 出版日期: 2013-02-20

Grading antiviral therapy in HCV-infected cirrhotic patients

摘要

摘要:
丙型肝炎病毒(HCV)感染是引起肝硬化、终末期肝病以及肝细胞癌的重要原因。慢性丙型肝炎的标准化治疗方案———聚乙二醇化干扰素α联合利巴韦林已取得了良好的效果,但进展至肝硬化尤其是失代偿期的患者多难以耐受干扰素的不良反应,给抗病毒治疗带来困难。面对我国丙型肝炎肝硬化比例较高、肝移植实施困难、对标准的抗病毒治疗方案应答率高的特点,参考国际指南,作者在国内率先探索和提出了丙型肝炎肝硬化分级标准及相应的抗病毒治疗策略,并进行了相关的临床研究和应用。依据作者提出的丙型肝炎肝硬化的分级方法,先采取不同的处置方法缓解脾亢或减少副作用后,再采用标准化抗病毒治疗方案,可以有效地延缓肝硬化的进展,减少HCV感染相关并发症,最终提高患者生活质量。
- 肝炎,丙型,慢性 /
- 肝硬化 /
- 抗病毒治疗
Abstract:
Chronic hepatitis C (CHC) is a major cause of cirrhosis, end-stage liver disease, and hepatocellular carcinoma.The combination drug regimen of pegylated interferon-alpha (PEG-IFNα) and ribavirin is the approved and well-accepted standard-of-care for CHC.However, CHC patients with decompensated cirrhosis usually have contraindications for the use of PEG-IFNα and ribavirin, and the results of therapy are generally poor.To address China's high prevalence of hepatitis C virus (HCV) -related cirrhosis, difficulties of implementing liver transplantation, and the higher sustained virological response rate seen in Chinese cirrhotic patients, we developed a grading strategy of antiviral therapy for Chinese patients with HCV-related cirrhosis based upon the clinical practice guidelines published by the American Association for the Study of Liver Diseases (AASLD) and the European Association for the Study of the Liver (EASL) .Clinical application of this strategy demonstrated it to be effective for slowing down the rate of cirrhosis progression, preventing complications of HCV-related liver disease, and improving the patients' quality of life.
- hepatitis C /
- chronic /
- liver cirrhosis

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参考文献(19)

[1]Shepard CW, Finelli L, Alter MJ.Global epidemiology of hep-atitis C virus infection[J].Lancet Infect Dis, 2005, 5 (9) :558-567.

[2]Te HS, Jensen DM.Epidemiology of hepatitis B and C viruses:a global overview[J].Clin Liver Dis, 2010, 14 (1) :1-21.

[3]Thomas DL, Seeff LB.Natural history of hepatitis C[J].ClinLiver Dis, 2005, 9 (3) :383-398.

[4]Seeff LB.The history of the“natural history”of hepatitis C (1968-2009) [J].Liver Int, 2009, 29 (Suppl 1) :89-99.

[5]Ghany MG, Strader DB, Thomas DL, et al.Diagnosis, man-agement, and treatment of hepatitis C:an update[J].Hepa-tology, 2009, 49 (4) :1335-1374.

[6]Asian Pacific Association for the Study of the Liver (APASL) Hepatitis C Working Party.Asian Pacific Association for theStudy of the Liver consensus statements on the diagnosis, management and treatment of hepatitis C virus infection[J].J Gastroenterol Hepatol, 2007, 22 (5) :615-633.

[7]Schmid M, Kreil A, Jessner W, et al.Suppression of haema-topoiesis during therapy of chronic hepatitis C with differentinterferon alpha mono and combination therapy regimens[J].Gut, 2005, 54 (7) :1014-1020.

[8]Lavanchy D.The global burden of hepatitis C[J].Liver Int, 2009, 29 (Suppl 1) :74-81.

[9]Liu CH, Liu CJ, Lin CL, et al.Pegylated interferon-alpha-2a plus ribavirin for treatment-naive Asian patients with hep-atitis C virus genotype 1 infection:a multicenter, randomizedcontrolled trial[J].Clin Infect Dis, 2008, 47 (10) :1260-1269.

[10]Ge D, Fellay J, Thompson AJ, et al.Genetic variation in IL28Bpredicts hepatitis C treatment-induced viral clearance[J].Na-ture, 2009, 461 (7262) :399-401.

[11]Suppiah V, Moldovan M, Ahlenstiel G, et al.IL28B is associ-ated with response to chronic hepatitis C interferon-alphaand ribavirin therapy[J].Nat Genet, 2009, 41 (10) :1100-1104.

[12]Iadonato SP, Katze MG.Genomics:Hepatitis C virus gets per-sonal[J].Nature, 2009, 461 (7262) :357-358.

[13]Shi XD, Jiang J, Niu JQ.Association of interleukin 28B (IL28B) polymorphisms with the outcomes of HCV infection[J].J ClinHepatol, 2011, 27 (1) :28-31. (in Chinese) 石晓东, 姜晶, 牛俊奇.白细胞介素28B的基因多态性与丙型肝炎病毒感染转归的关系[J].临床肝胆病杂志, 2011, 27 (1) :28-31.

[14]European Association for the Study of the Liver.EASL ClinicalPractice Guidelines:management of hepatitis C virus infec-tion[J].J Hepatol, 2011, 55 (2) :245-264.

[15]Liao XW, Ling Y, Li XH, et al.Association of genetic varia-tion in IL28B with hepatitis C treatment-induced viral clear-ance in the Chinese Han population[J].Antivir Ther, 2011, 16 (2) :141-147.

[16]Ghany MG, Nelson DR, Strader DB, et al.An update ontreatment of genotype 1 chronic hepatitis C virus infection:2011 practice guideline by the American Association for theStudy of Liver Diseases[J].Hepatology, 2011, 54 (4) :1433-1444.

[17]Garcia-Retortillo M, Forns X, Feliu A, et al.Hepatitis C vi-rus kinetics during and immediately after liver transplantation[J].Hepatology, 2002, 35 (3) :680-687.

[18]Wei X, Xie YM, Chen L, et al.Antiviral therapy with pegylat-ed interferon alpha-2a plus ribavirin in patients with HCV re-lated cirrhosis and to establish the grading for standard thera-py[J].J Clin Hepatol, 2011, 27 (1) :89-92. (in Chinese) 魏欣, 谢玉梅, 陈琳, 等.丙型肝炎肝硬化的“分级”及聚乙二醇干扰素ɑ-2a联合利巴韦林的抗病毒治疗[J].临床肝胆病杂志, 2011, 27 (1) :89-92.

[19] Xie YM, Li B, Ma L, et al.Peg-IFNα-2a/RBV antiviral ef-ficacy in cirrhotic hepatitis C patients after splenectomy orpartial splenic embolization[J].Chin J Hepatol, 2012, 20 (2) :112-115. (in Chinese) 谢玉梅, 李冰, 马力, 等.丙型肝炎肝硬化患者脾切除或部分脾栓塞术后抗病毒治疗的疗效观察[J].中华肝脏病杂志, 2012, 20 (2) :112-115.

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