肝移植术后丙型肝炎复发抗病毒疗效分析

Anti-viral treatment of recurrent hepatitis C after liver transplantation

  • 摘要: 目的 分析肝移植术后HCV复发抗病毒治疗疗效。方法 我院2005年1月-2010年6月收治的12例肝移植术后HCV复发给予干扰素联合利巴韦林抗病毒治疗的患者,采用小剂量递增的方法进行治疗。观察HCV RNA载量、快速病毒学应答(RVR)、早期病毒学应答(EVR)、治疗结束时病毒学应答(ETVR)、持续病毒学应答(SVR)以及抗病毒治疗中的不良反应。结果 12例抗病毒开始治疗时间平均为移植后15个月(2-36个月),7例完成了标准抗病毒疗程。12例中,3例获得RVR,9例EVR,8例ETVR,3例SVR。3例获得SVR中,2例HCV RNA基因型为1b,1例2a;2例获得RVR,3例均获得EVR。抗病毒治疗中,5例提前终止治疗,其中1例因粒细胞显著下降、2例因急性排斥反应、1例因严重感染以及1例因过敏反应。结论 肝移植术后抗HCV治疗SVR较低,在抗病毒治疗过程中,应严密监测药物不良反应,集落刺激因子有助于患者完成抗病毒疗程。

     

    Abstract: Objective To analyze the curative effect of anti-viral treatment on recurrent hepatitis C after liver transplantation.Methods Twelve patients with recurrent hepatitis C after liver transplantation admitted to our hospital from January 2005 to June 2010 were treated with interferon(IFN) plus ribavirin by increasing their dose gradually.Following parameters were observed,including HCVRNA load,rapid viral response(RVR),early viral response(EVR),end of treatment viral response(ETVR),sustained viral response(SVR) to anti-viral therapy and its side effects.Results The mean treatment time for the 12 patients with recurrent hepatitis C after liver transplantation was 15 months(2-36 months) and 7 patients(58.3%) completed their standard anti-viral treatment.RVR,EVR,ETVR and SVR were achieved in 3(25%),9(75%),8(58.3%) and 3(25%) out of the 12 patients.HCVRNA genotype 1 was isolated in 2 and genotype 2 in 1 out of the 3 patients who had a SVR.RVR was achieved in 2 patients and EVR in 3 patients,respectively.Anti-viral treatment was terminated in 5 patients due to neutropenia in 1 patient,acute rejection in 2 patients,severe infection in 1 patient and allergy in 1 patient,respectively.Conclusion The SVR of patients with recurrent hepatitis C after liver transplantation is low to anti-viral treatment.Side effects of anti-viral treatment should be closely monitored.Colony stimulating factor is beneficial for the patients to complete their anti-viral treatment.

     

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