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基于索磷布韦方案治疗HCV相关性肾小球肾炎的效果和安全性
Clinical effect and safety of sofosbuvir-based regimens in treatment of hepatitis C virus-associated glomerulonephritis
文章发布日期:2019年07月05日  来源:  作者:贺彩妮,李彧,葛蘅,等  点击次数:139次  下载次数:9次

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【摘要】:目的探讨基于索磷布韦方案治疗HCV相关性肾小球肾炎的疗效和安全性。方法回顾性分析2015年4月-2018年10月西安交通大学第二附属医院5例HCV相关性肾小球肾炎患者接受基于索磷布韦方案抗病毒药物治疗的效果和安全性。评估治疗结束12周持续病毒学应答(SVR12),治疗过程和治疗结束肝肾功能、尿蛋白的变化和安全性。结果5例患者纳入研究,年龄27~81岁;4例男性,2例合并肝硬化;4例基因1b,1例基因2a。2例患者进行肾活组织检查,病理诊断分别为膜增生性肾小球肾炎和系膜增生性肾小球肾炎。患者接受索磷布韦+利巴韦林 (n=2)、雷迪帕韦/索磷布韦 (n=2)和索磷布韦/维帕他韦 (n=1) 治疗12或24周。5例患者均取得SVR12。与基线相比,治疗结束和随访12周ALT明显降低,24 h尿蛋白定量明显降低伴有血清白蛋白水平的轻度升高,血清尿素氮和肌酐改善或维持不变。仅有1例患者出现利巴韦林相关的消化道副作用。结论基于索磷布韦的无干扰素方案治疗HCV相关性肾小球肾炎有效且耐受性良好。需要长期随访患者以明确HCV清除后肾脏疾病的长期预后。
【Abstract】:ObjectiveTo investigate the clinical effect and safety of sofosbuvir-based regimens in the treatment of hepatitis C virus (HCV)-associated glomerulonephritis (HCV-GN). MethodsA retrospective analysis was performed for the clinical data of 5 patients with HCV-GN who were given sofosbuvir-based antiviral therapy in The Second Affiliated Hospital of Xi’an Jiaotong University from April 2015 to October 2018, and their clinical outcome and safety were analyzed. The patients were evaluated in terms of sustained virologic response at 12 weeks after treatment ended (SVR12), changes in liver/renal function and urinary protein during and after treatment, and safety. ResultsFive patients were enrolled, with an age of 27-81 years. There were 4 male patients, among whom 2 had liver cirrhosis. Of all patients, 4 had genotype 1b and 1 had genotype 2a. Renal biopsy was performed for 2 patients, who were diagnosed with membranoproliferative glomerulonephritis and mesangial proliferative glomerulonephritis, respectively. Of all patients, 2 received sofosbuvir+ribavirin, 2 received ledipasvir/sofosbuvir, and 1 received sofosbuvir/velpatasvir for 12 or 24 weeks. All 5 patients achieved SVR12. There were significant reductions in alanine aminotransferase and 24-hour urinary protein excretion from baseline to the end of treatment and 12 weeks of follow-up, with a slight increase in serum albumin. Blood urea nitrogen and serum creatinine were improved or showed no change. Only 1 patient experienced adverse gastrointestinal events associated with ribavirin. ConclusionSofosbuvir-based regimens have good clinical effect and tolerability in patients with HCV-GN. Long-term follow-up should be performed to evaluate the long-term prognosis of renal disease after HCV clearance.
【关键字】:肝炎病毒属; 肾小球肾炎; 索磷布韦; 抗病毒药
【Key words】:hepacivirus; glomerulonephritis; sofosbuvir; antiviral agents
【引证本文】:HE CN, LI Y, GE H, et al. Clinical effect and safety of sofosbuvir-based regimens in treatment of hepatitis C virus-associated glomerulonephritis[J]. J Clin Hepatol, 2019, 35(8): 1714-1718. (in Chinese)
贺彩妮, 李彧, 葛蘅, 等. 基于索磷布韦方案治疗HCV相关性肾小球肾炎的效果和安全性[J]. 临床肝胆病杂志, 2019, 35(8): 1714-1718.

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