直接抗病毒药物在丙型肝炎肝硬化患者中的应用进展

冉锡萍; 蔡大川

doi:10.12449/JCH240828

直接抗病毒药物在丙型肝炎肝硬化患者中的应用进展

DOI: 10.12449/JCH240828

冉锡萍¹,
蔡大川^2, , ,

1.
重庆医科大学附属第二医院感染病科，重庆 401336
2.
感染性疾病分子生物学教育部重点实验室，重庆医科大学病毒性肝炎研究所，重庆 400010

基金项目:

重庆市科卫联合医学科研重点项目 (2022ZDXM001);

重庆市首批公共卫生重点学科（专科）

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：冉锡萍负责查阅相关文献，分析/解释数据和起草文章；蔡大川负责对文章的知识性内容作批评性审阅与指导。

详细信息

通信作者:
蔡大川， cqmucdc@cqmu.edu.cn （ORCID： 0000-0003-3269-8549）

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出版历程
- 收稿日期: 2023-12-12
- 录用日期: 2024-01-12
- 出版日期: 2024-08-25

Advances in the application of direct-acting antivirals in patients with hepatitis C cirrhosis

Xiping RAN¹,
Dachuan CAI^{2
, ,
,}

1.
Department of Infectious Diseases，The Second Affiliated Hospital of Chongqing Medical University，Chongqing 401336，China
2.
Key Laboratory of Molecular Biology of Infectious Diseases Designated by the Chinese Ministry of Education，Institute for Viral Hepatitis，Chongqing Medical University，Chongqing 400010，China

Research funding:

Chongqing Medical Scientific Research Key Project （Joint Project of Chongqing Health Commission and Science and Technology Bureau） (2022ZDXM001);

The First Batch of Key Disciplines on Public Health in Chongqing

More Information

Corresponding author: CAI Dachuan， cqmucdc@cqmu.edu.cn （ORCID： 0000-0003-3269-8549）

摘要

摘要: 慢性丙型肝炎病毒感染可导致肝硬化的发生，肝硬化后出现肝细胞癌等并发症是慢性肝病患者的主要死亡原因。抗病毒治疗可以实现持续病毒学应答，改善肝炎、肝纤维化，进而延缓病程进展。直接抗病毒药物（DAA）在丙型肝炎肝硬化患者中的安全性和有效性已被证实，其是否能改善肝硬化患者疾病并发症和预后逐渐成为讨论和研究的热点。相关数据主要由国外学者报告，我国DAA上市较晚，尚缺乏中远期数据。本文回顾了最新的相关研究，对DAA在丙型肝炎肝硬化患者中的应用现状及其对临床预后的影响进行综述。
- 肝炎病毒属 /
- 肝硬化 /
- 直接抗病毒药物 /
- 治疗结果
Abstract: Chronic hepatitis C virus （HCV） infection can lead to liver cirrhosis， and complications after liver cirrhosis， including hepatocellular carcinoma （HCC）， are the leading causes of death in patients with chronic liver diseases. Antiviral therapy can help to realize sustained virologic response， improve hepatitis and liver fibrosis， and delay disease progression. The safety and efficacy of direct-acting antivirals （DAAs） have been confirmed in patients with HCV-related liver cirrhosis， and whether DAAs can improve the complications and prognosis of patients with liver cirrhosis has gradually become a research hotspot. Related data are mainly reported by foreign scholars， and since DAAs have not been marketed in China for a long time， there is still a lack of mid- and long-term data. This article reviews the latest studies on the application of DAAs in patients with HCV-related liver cirrhosis and the impact of DAAs on clinical prognosis.
- Hepacivirus /
- Liver Cirrhosis /
- Direct-Acting Antivirals /
- Treatment Outcome

HTML全文

表 1 近3年报道丙型肝炎代偿期肝硬化患者使用DAA达SVR后HCC发病风险的研究

Table 1. Summary of studies related to the risk of HCC in patients with compensated liver cirrhosis using DAA to achieve SVR in the last three years

作者	年份	研究地点	研究类型	总人数（例）	随访时间	HCC（例）	发病（%）	发病率（%/人年）
Kondili等^［35］	2023	意大利	前瞻性	1 839	28.47个月	98	5.33
Ciancio等^［36］	2023	意大利	前瞻性	1 000	48个月	71	7.10	1.97
Choi等^［37］	2022	韩国	前瞻性	218	4.1年	17	7.80	2.89
Semmler等^［38］	2022	奥地利	前瞻性	475	41个月	22	4.60	1.45
Sanduzzi-zamparelli等^［39］	2022	西班牙	前瞻性	122	48个月	10	8.20	2.24
Younossi等^［40］	2022	美国	前瞻性	730	168周	37	5.07
D’ambrosio等^［41］	2022	意大利	前瞻性	480	51个月	32	6.67

下载: 导出CSV

表 2 近3年报道丙型肝炎失代偿期肝硬化患者使用DAA达SVR后HCC发病风险的研究

Table 2. Summary of studies related to the risk of HCC in patients with decompensated liver cirrhosis using DAA to achieve SVR in the last three years

作者	年份	研究地点	研究类型	总人数（例）	随访时间	HCC（例）	发病（%）	发病率（%/人年）
Kondili等^［35］	2023	意大利	前瞻性	225	28.47个月	21	9.33
Semmler等^［38］	2022	奥地利	前瞻性	52	41个月	12	23.10	7.00
Younossi等^［40］	2022	美国	前瞻性	124	168周	21	16.94
D’ambrosio等^［41］	2022	意大利	前瞻性	89	51个月	14	15.73

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