摘要
目的观察索磷布韦维帕他韦联合利巴韦林治疗慢性丙型肝炎的疗效和对患者细胞因子与趋化因子及抗肝纤维化效果的影响。方法选取2018年10月—2020年10月荆州市第二人民医院收治的慢性丙型肝炎患者68例,采用区组随机化法分为观察组33例,对照组35例。对照组予干扰素α-2b联合利巴韦林方案治疗,观察组予索磷布韦维帕他韦片联合利巴韦林方案治疗,2组均治疗3个月。比较2组治疗效果[快速病毒学应答(RVR)、早期病毒学应答(EVR)],治疗前后血清细胞因子/趋化因子[白介素-6(IL-6)、干扰素诱导蛋白-10(IP-10)、单核细胞趋化蛋白-4(MCP-4)、巨噬细胞炎性蛋白-3α(MIP-3α)]水平变化与肝纤维化指标[Ⅳ型胶原蛋白(Col-Ⅳ)、层粘连蛋白(LN)、Ⅲ型前胶原(PC-Ⅲ)、透明质酸钠(HA)]差异及不良反应。结果观察组RVR及EVR均高于对照组(72.73%vs.45.71%&87.88%vs.62.86%,χ^(2)_(RVR)=5.117,P RVR=0.024;χ^(2) EVR=5.672,P_(EVR)=0.017);治疗3个月后,2组IL-6、IP-10、MCP-4、MIP-3α水平和Col-Ⅳ、LN、PC-Ⅲ、HA水平均较治疗前下降,且观察组低于对照组(P<0.05或P<0.01);2组不良反应总发生率(18.18%vs.28.57%)比较差异无统计学意义(χ^(2)=1.019,P=0.313)。结论索磷布韦维帕他韦联合利巴韦林治疗慢性丙型肝炎效果较好,对控制细胞因子与趋化因子及抗肝纤维化等方面具有积极影响,且不会增加不良反应发生风险,值得临床推广应用。
Objective To observe the efficacy of sothibuvir/vepatavir and ribavirin in the treatment of chronic hepatitis C and its effects on cytokines,chemokines and anti hepatic fibrosis.Methods Sixty-eight patients with chronic hepatitis C treated in Jingzhou Second People′s Hospital from October 2018 to October 2020 were selected.The patients were divided into observation group(33 cases)and control group(35 cases)by block randomization method.The control group was given interferonα-2b combined with ribavirin regimen.The observation group was treated with sothibuvir/vepatavir tablets and ribavirin regimen.Both groups were treated for 3 months.The therapeutic effects(RVR,EVR),the changes of serum cytokines/chemokines(IL-6、IP-10、MCP-4、MIP-3α)and liver fibrosis indexes(Col-Ⅳ、LN、PC-Ⅲ、HA)before and after treatment,as well as adverse reactions were compared between the two groups.Results RVR and EVR in the observation group were significantly higher than those in the control group(72.73%vs.45.71%&87.88%vs.62.86%,χ^(2)_(RVR)=5.117,P_(RVR)=0.024;χ^(2)_(EVR)=5.672,P_(EVR)=0.017).After 3 months of treatment,the level of IL-6,IP-10,MCP-4,MIP-3α,Col-Ⅳ,LN,PC-Ⅲand HA in the two groups decreased compared with that before treatment,and the degree of decline in the observation group was greater than that in the control group(P<0.05 or P<0.01).There was no significant difference in the total incidence of adverse reactions between the two groups(18.18%vs.28.57%,χ^(2)=1.019,P=0.313).Conclusion Sothibuvir/vapatavir combined with ribavirin is effective in the treatment of chronic hepatitis C.It has a positive impact on the control of cytokines and chemokines and anti liver fibrosis,and will not increase the risk of adverse reactions.It is worthy of clinical application.
作者
孙娜
SUN Na(Department of HepatologyⅠ,Jingzhou Second People′s Hospital,Hubei Province,Jingzhou 434000,China)
出处
《临床合理用药杂志》
2022年第23期20-23,共4页
Chinese Journal of Clinical Rational Drug Use
