直接抗病毒治疗肾移植术后丙肝患者的疗效和安全性

doi:10.6040/j.issn.1671-7554.0.2018.075

摘要/Abstract

摘要： 目的评估肾移植术后丙肝患者直接抗病毒治疗的疗效和安全性。方法回顾分析7例肾移植术后感染丙型肝炎病毒(HCV)且采用了直接抗病毒治疗患者的相关资料,统计分析患者在抗病毒治疗前,治疗2、4、12周,治疗结束后12、24、48周时的丙型肝炎病毒RNA复制量(HCV RNA)、丙氨酸氨基转移酶(ALT)、肾小球滤过率(eGFR)以及血肌酐水平等相关数据来评估直接抗病毒治疗的疗效和安全性,并分析了治疗后1年时的生存情况。结果纳入研究的7例患者经为期12周的直接抗病毒治疗后,所有患者HCV RNA转为阴性,其血清学检测快速病毒学应答(RVR)为100%(7/7),SVR12、SVR24为100%;ALT在抗病毒治疗2周时与治疗前相比具有明显变化,此后ALT水平保持稳定;整个研究期间eGFR、血肌酐水平保持稳定。结论肾移植术后丙肝患者给予直接抗病毒治疗的疗效和安全性是可靠的,研究期间移植肾功能稳定。

关键词: 肾移植, 慢性丙型肝炎, 直接抗病毒治疗, 病毒学应答

Abstract: Objective To assess the efficacy and safety of direct-acting antiviral(DAA)therapy for hepatitis C after renal transplantation. Methods By a retrospective analysis, we recruited seven patients who were infected with hepatitis C virus(HCV RNA)and treated with direct-acting antiviral agents therapy after kidney transplantation in our transplantation department. Serum HCV RNA, alanine transaminase(ALT), estimate glomerular filtration rate(eGFR)and serum creatinine level were measured at baseline, 2^nd, 4^th, 12^th week of treatment, and 12^th, 24^th, 48^th week after the treatment. Survival rate of these patients at 1 year post-therapy was analyzed. Results Seven kidney graft recipients infected with HCV were enrolled in our study. All these patients were given DAA therapy for 12 weeks. At the end of therapy, HCV RNA was negative in all patients. The serological test had a rapid virologic response(RVR)of 100%(7/7), SVR12, SVR24 were 100%, and ALT at 2^th week of treatment had improvement compared with that before treatment. ALT levels remained stable thereafter; eGFR and blood muscle levels remained stable throughout the study period. Conclusion During the 1 year follow-up period, the therapy for patients infected with hepatitis C virus after kidney transplantation is safe and effective, and kidney function after transplantation was relatively stable during the research period.

Key words: Kidney transplantation, Chronic hepatitis, Direct-acting antiviral agents, Virologic response

中图分类号:

R692

卯怡杰,张旭峰,刘双德,刘晓立,焉杰克,徐东升,潘稳固,田川. 直接抗病毒治疗肾移植术后丙肝患者的疗效和安全性[J]. 山东大学学报 (医学版), 2019, 57(1): 75-80.

MAO Yijie, ZHANG Xufeng, LIU Shuangde, LIU Xiaoli, YAN Jieke, XU Dongsheng, PAN Wengu, TIAN Chuan. Efficacy and safety of direct-acting antiviral therapy for hepatitis C after renal transplantation[J]. Journal of Shandong University (Health Sciences), 2019, 57(1): 75-80.

参考文献

[1] Poveda E, Wyles DL, Mena A, et al. Update on hepatitis C virus resistance to direct-acting antiviral agents[J]. Antiviral Res, 2014, 108(4): 181-191.
[2] Ju W, Yang S, Feng S, et al. Hepatitis C virus genotype and subtype distribution in Chinese chronic hepatitis C patients: nationwide spread of HCV genotypes 3 and 6[J]. Virol J, 2015, 12(1): 1-6.
[3] 聂红明, 陈建杰, 汪蓉,等. 中国汉族人群慢性丙型肝炎病毒基因型分布规律研究[J]. 中华流行病学杂志,2012, 33(5): 501-504. NIE Hongming, CHEN Jianjie, WANG Rong, et al. Genotypes distribution of hepatitis C virus through multi-center, large sample studies among chronic hepatitis C patients in Chinese Han population[J]. Chinese Journal of Epidemiology, 2012, 33(5): 501-504.
[4] Ghaderi Zefrehi H, Gholami Fesharaki M,et al. The distribution of hepatitis C virus genotypes in middle eastern countries: a systematic review and meta-analysis[J]. Hepat Mon, 2016, 16(9): e40357. doi: 10.5812/hepatmon.40357.
[5] Omata M, Kanda T, Wei L, et al. APASL consensus statements and recommendations for hepatitis C prevention, epidemiology, and laboratory testing[J]. HepatolInt, 2016, 10(5): 681-701.
[6] Scott N, McBryde E, Vickerman P, et al. The role of a hepatitis C virus vaccine: modelling the benefits alongside direct-acting antiviral therapys[J]. BMC Med, 2015, 13: 198. doi: 10.1186/s12916-015-0440-2.
[7] Bunchorntavakul C, Maneerattanaporn M, Chavalitdhamrong D. Management of patients with hepatitis C infection and renal disease[J]. World J Hepatol, 2015, 7(2): 213-225.
[8] Signorovitch JE, Betts KA, Song Y, et al. Comparative efficacy and safety of daclatasvir/asunaprevirversus IFN-based regimens in genotype 1b hepatitis C virus infection[J]. J Comp Eff Res, 2015, 4(6): 593-605.
[9] Hundemer GL, Sise ME, Wisocky J, et al. Use of sofosbuvir-based direct-acting antiviral therapy for hepatitis C viral infection in patients with severe renal insufficiency[J]. Infect Dis(Lond), 2015, 47(12): 924-929.
[10] Kamar N, Marion O, Rostaing L, et al. Efficacy and safety of sofosbuvir-based antiviral therapy to treat hepatitis C virus infection after kidney transplantation[J]. Am J Transplant, 2016, 16(5): 1474-1479.
[11] 魏来, 侯金林, 陈红松, 等. 丙型肝炎防治指南(2015年更新版)[J].中华肝脏病杂志, 2015,23(12): 906-923. WEI Lai, HOU Jinlin, CHEN Hongsong, et al. The guideline of prevention and treatment for hepatitis C: a 2015 update[J]. Chinese journal of hepatology, 2015, 23(12): 906-923.
[12] Gentil GMA, Esforzado N, Cruzado JM, et al. Harmful effects of viral replication in sero-positive hepatitis C virus renal transplant recipients[J]. Transplantation, 2012, 94(11): 1131-1137.
[13] 张萍, 段志强, 杨丽南,等. 丙肝病毒感染的肾移植受者的临床观察[J]. 西南国防医药, 2015, 25(4): 377-380.
[14] Cai Q, Zhang X, Lin C, et al. 24 versus 48 weeks of peginterferon plus ribavirin in hepatitis C virus genotype 6 chronically infected patients with a rapid virological response: anon-inferiority randomized controlled trial[J]. PLoS One, 2015, 10(10): e0140853.doi: 10.1371/journal.pone.0140853
[15] Yu ML, Dai CY, Huang JF, et al. A randomised study of peginterferon and ribavirin for 16 versus 24 weeks in patients with genotype 2 chronic hepatitis C[J]. Gut, 2007, 56(4): 553-559.
[16] Ge YZ, Wu R, Jia RP, et al. Association between interferon gamma +874 T>A polymorphism and acute renal allograft rejection: evidence from published studies[J]. MolBiol Rep, 2013, 40(10): 6043-6051.
[17] Brown RS, O'Leary JG, Reddy KR, et al. Interferon-free therapy for genotype 1 hepatitis C in liver transplant recipients: Real-world experience from the hepatitis C therapeutic registry and research network[J]. Liver Transpl, 2016, 22(1): 24-33.
[18] Hézode C, Lebray P, De Ledinghen V, et al. Daclatasvir plus sofosbuvir, with or without ribavirin, for hepatitis C virus genotype 3 in a French early access programme[J]. Liver Int, 2017, 37(9): 1314-1324.
[19] Hussein NR, Saleem ZS. Successful treatment of hepatitis C virus genotype 4 in renal transplant recipients with direct-acting antiviral agents[J]. Am J Transplant, 2016, 16(7): 2237-2238.
[20] Sawinski D, Kaur N, Ajeti A, et al. Successful treatment of Hepatitis C in Renal Transplant Recipients With Direct-Acting Antiviral Agents[J]. Am J Transplant, 2016, 16(5): 1588-1595.
[21] Tabernilla A, Grandal M, Pernas B, et al. Viral dynamics among hepatitis C virus chronic infected patients during direct-acting antiviral agents therapy: impact for monitoring and optimizing therapy duration[J]. Eur J Gastroenterol Hepatol, 2017, 29(7): 781-785.
[22] Rostaing L, Alric L, Kamar N. Use of direct-acting agents for hepatitis C virus-positive kidney transplant candidates and kidney transplant recipients[J]. TransplInt, 2016, 29(12): 1257-1265.
[23] Lin MV, Sise ME, Pavlakis M, et al. Efficacy and safety of direct acting antivirals in kidney transplant recipients with chronic hepatitis C virus infection[J]. PLoS One, 2016, 11(7): e0158431. doi: 10.1371/journal.pone.0158431.
[24] Kamar N, Marion O, Rostaing L, et al. Efficacy and safety of sofosbuvir-based antiviral therapy to treat hepatitis C virus infection afterkidney transplantation[J]. Am J Transplant, 2016, 16(5): 1474-1479.
[25] 牛英,明英姿,佘兴国,等. 直接抗病毒药物治疗肾移植术后丙型病毒性肝炎疗效与安全性的临床观察[J]. 器官移植, 2017, 1(8): 49-53. NIU Ying, MING Yingzi, SHE Xingguo, et al. Preliminary observation of clinical efficacy and safety of direct-acting antiviral agents for hepatitis C virus following renal transplantation[J]. Organ Transplantation, 2017, 1(8): 49-53.
[26] Beinhardt S, Al Zoairy R, Ferenci P, et al. DAA-based antiviral treatment of patients with chronic hepatitis C in the pre- and post-kidney transplantation setting[J]. Transpl Int, 2016, 29(9): 999-1007.

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