Iacobellis Angelo, Ippolito Antonio, Andriulli Angelo
"Casa Sollievo della Sofferenza" Hospital, IRCCS, viale Cappuccini 1, San Giovanni Rotondo 71013, Italy.
World J Gastroenterol. 2008 Nov 14;14(42):6467-72. doi: 10.3748/wjg.14.6467.
The main goals of treating cirrhotic patients with antiviral therapy are to attain sustained viral clearance (SVR), halt disease progression, and prevent re-infection of the liver graft. However, while the medical need is great, the use of interferon and ribavirin might expose these patients to severe treated-related side effects as a large proportion of them have pre-existing hematological cytopenias. We have reviewed potential benefits and risks associated with antiviral drugs in patients with liver cirrhosis, due to hepatitis C virus (HCV) infection. In cases presenting with bridging fibrosis or cirrhosis, current regimens of antiviral therapy have attained a 44%-48% rate of SVR. In cirrhotic patients with portal hypertension, the SVR rate was 22% overall, 12.5% in patients with genotype 1, and 66.7% in those with genotypes 2 and 3 following therapy with low doses of either Peg-IFN alpha-2b and of ribavirin. In patients with decompensated cirrhosis, full dosages of Peg-IFN alpha-2b and of ribavirin produced a SVR rate of 35% overall, 16% in patients with genotype 1 and 4, and 59% in those with genotype 2 and 3. Use of hematological cytokines will either ensure full course of treatment to be accomplished with and prevent development of treatment-associated side effects. Major benefits after HCV eradication were partial recovery of liver metabolic activity, prevention of hepatitis C recurrence after transplantation, and removal of some patients from the waiting list for liver transplant. Several observations highlighted that therapy is inadvisable for individuals with poor hepatic reserve (Child-Pugh-Turcotte score >= 10). Although SVR rates are low in decompensated cirrhotics due to hepatitis C, these patients have the most to gain as successful antiviral therapy is potentially lifesaving.
使用抗病毒疗法治疗肝硬化患者的主要目标是实现持续病毒清除（SVR）、阻止疾病进展并预防肝移植再感染。然而，尽管医疗需求巨大，但由于这些患者中很大一部分已有血液学血细胞减少症，使用干扰素和利巴韦林可能会使他们面临严重的治疗相关副作用。我们回顾了丙型肝炎病毒（HCV）感染所致肝硬化患者使用抗病毒药物的潜在益处和风险。在出现桥接纤维化或肝硬化的病例中，当前的抗病毒治疗方案已实现44%-48%的SVR率。在门静脉高压的肝硬化患者中，总体SVR率为22%，基因1型患者为12.5%，基因2型和3型患者在接受低剂量聚乙二醇干扰素α-2b和利巴韦林治疗后SVR率为66.7%。在失代偿期肝硬化患者中，全剂量的聚乙二醇干扰素α-2b和利巴韦林总体产生35%的SVR率，基因1型和4型患者为16%，基因2型和3型患者为59%。使用血液学细胞因子将确保完成整个疗程并预防治疗相关副作用的发生。根除HCV后的主要益处包括肝脏代谢活性部分恢复、预防移植后丙型肝炎复发以及使一些患者从肝移植等待名单中移除。一些观察结果强调，对于肝储备功能差（Child-Pugh-Turcotte评分≥10）的个体，治疗是不可取的。尽管丙型肝炎所致失代偿期肝硬化患者的SVR率较低，但这些患者可能获益最大，因为成功的抗病毒治疗可能挽救生命。
