慢性丙型肝炎合并肾功能不全患者直接抗病毒药物治疗的选择

摘要

The incidence of hepatitis C virus infection is commonly seen in patients with renal dysfunction (RD),especially those with end-stage renal disease on hemodialysis (HD),among whom the incidence and mortality of liver diseases increase.The development of direct-acting antiviral agents has revolutionized the therapy for chronic hepatitis C (CHC) with a sustained virologic response rate of ＞ 90％ and a low rate of adverse events.Grazoprevir/elbasvir,paritaprevir/ritonavir + ombitasvir + dasabuvir,glecaprevir/pibrentasvir,or daclatasvir + asunaprevir regimen is recommended in CHC patients with RD and HD,while the sofosbuvir-based regimen is not recommended.%HCV感染在肾功能不全(RD)患者中较常见,尤其是在终末期肾病进行血液透析(HD)的患者中,感染率明显高于普通人群,肝脏疾病的发生率及病死率升高.直接抗病毒药物在慢性丙型肝炎的治疗中取得了超过90％的持续病毒学应答和较少的不良事件.在合并RD和HD患者中推荐应用grazoprevir/elbasvir、paritaprevir/ritonavir+ombitasvir+ dasabuvir、glecaprevir/pibrentasvir或daclartasvir+ asunaprevir等治疗方案,不建议推荐以sofosbuvir为基础的治疗方案.