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重庆医科大学病毒性肝炎研究所感染性疾病分子生物学教育部重点实验室重庆医科大学附属第二医院感染科
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[1]唐巧,胡鹏.丙型肝炎病毒基因3型抗病毒治疗方案、临床效果及影响因素[J/OL].保健医学研究与实践:1-10[2021-06-23].http://kns.cnki.net/kcms/detail/50.1184.R.20210607.0953.002.html.
Tang Qiao, Hu Peng. Antiviral treatment regimens, clinical effect and impact factors of hepatitis C virus genotype 3[J/OL]. Health Medicine Research and Practice, 2021.
[1]唐巧,胡鹏.丙型肝炎病毒基因3型抗病毒治疗方案、临床效果及影响因素[J/OL].保健医学研究与实践:1-10[2021-06-23].http://kns.cnki.net/kcms/detail/50.1184.R.20210607.0953.002.html. DOI:
Tang Qiao, Hu Peng. Antiviral treatment regimens, clinical effect and impact factors of hepatitis C virus genotype 3[J/OL]. Health Medicine Research and Practice, 2021. DOI:
泛基因型直接作用抗病毒药物(DAAs)如索磷布韦/韦帕他韦、格卡瑞韦/哌仑他韦及索磷布韦/韦帕他韦/伏西瑞韦等,使得难治性基因3型的抗病毒效果明显提高。但基因3b型、肝硬化、经治及存在耐药相关性突变的患者,DAAs的抗病毒效果相对较差。对于基因3b型合并肝硬化患者可以考虑加用利巴韦林及延长治疗疗程以提高抗病毒效果,对于干扰素联合利巴韦林或DAAs经治的基因3型患者,可使用索磷布韦/韦帕他韦/伏西瑞韦治疗。与DAAs治疗后未获得持续病毒学应答(SVR)的患者相比,获得SVR可明显降低肝细胞癌(HCC)的发生风险,但仍有部分HCV感染患者,即使获得SVR,仍有HCC的发生,尤其是合并肝硬化患者。因此,对于DAAs治疗后未获得SVR、存在肝硬化的患者需要密切监测HCC发生。DAAs的使用与HCC的发生及复发风险无关。
The advent of pangenotypic direct antiviral drugs(DAAs),such as sofosbuvir/velpatasvir,glecaprevir/pibrentasvir,sofosbuvir/velpatasvir/voxilap-revir,significantly improve the antiviral effect in patients with genotype 3 infection,which is difficult to treat. However, the antiviral effect of DAAs is relatively poor in patients with genotype 3b infection, liver cirrhosis, treatment experienced and drug resistance-related mutations. For patients infected with genotype 3b complicated with liver cirrhosis, ribavirin can be added and the course of treatment can be prolonged to improve the antiviral effect. Patients with genotype 3 infection,who failed to achieve sustained virological response in the treatment with interferon combined with ribavirin or DAAs can be retreated with sofosopvir / verapatavir / fusirivir. Comparing with patients who failed to achieve SVR after DAAs treatment, obtaining SVR can significantly reduce the risk of hepatocellular carcinoma(HCC). But even if they obtained SVR, there is still at a risk of HCC occurrence, especially in patients with liver cirrhosis. Therefore, it is necessary to monitor closely the occurrence of HCC in patients with liver cirrhosis who failed to achieve SVR after DAAs treatment.The administration of DAAs was not associated with the occurrence and recurrence of HCC.
丙型肝炎病毒基因3型直接作用抗病毒药物肝细胞癌
hepatitis C virusgenotype 3direct acting antiviral drugsHepatocellular carcinoma
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