Tsuge Masataka, Hiramatsu Akira, Shinohara Fumi, Nakano Norihito, Nakamura Yuki, Hatooka Masahiro, Morio Kei, Morio Reona, Kan Hiromi, Fujino Hatsue, Uchida Takuro, Kobayashi Tomoki, Fukuhara Takayuki, Masaki Keiichi, Nakahara Takashi, Ono Atsushi, Nagaoki Yuko, Miki Daiki, Kawaoka Tomokazu, Hiraga Nobuhiko, Imamura Michio, Kawakami Yoshiiku, Aikata Hiroshi, Ochi Hidenori, Nelson Hayes C, Chayama Kazuaki
Department of Gastroenterology and Metabolism, Applied Life Science, Institute of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan.
Liver Research Project Center, Hiroshima University, Hiroshima, Japan.
Hepatol Res. 2016 Aug;46(9):944-8. doi: 10.1111/hepr.12629. Epub 2016 Jan 30.
Recently, treatments for chronic hepatitis C virus (HCV) infection have been drastically improved by the development of direct-acting antiviral agents. In September 2014, dual oral therapy using daclatasvir (DCV) and asunaprevir (ASV) was approved for the treatment of chronic HCV infection in Japan. We treated a patient with HCV-related liver cirrhosis with severe leg edema due to chronic renal dysfunction using this dual oral therapy. Although serum alanine aminotransferase increased rapidly during the first week of treatment, the antiviral therapy was able to continue, and liver function recovered spontaneously. After 1 month of treatment, serum HCV RNA became continuously undetectable, and serum albumin level gradually increased. Throughout the therapy, serum creatinine level nearly normalized, and leg edema gradually improved. These improvements continued after the combination therapy was completed. HCV RNA remained undetectable following the end of therapy, and sustained virological response at 12 weeks was achieved. It has been reported that chronic HCV infection is associated with renal dysfunction and that HCV eradication can improve it. DCV and ASV combination therapy is safe for patients who have renal dysfunction and may be a suitable therapy for chronic hepatitis C patients with renal dysfunction.
近年来，随着直接抗病毒药物的研发，慢性丙型肝炎病毒（HCV）感染的治疗方法有了显著改善。2014年9月，日本批准使用达拉他韦（DCV）和阿舒瑞韦（ASV）的双重口服疗法治疗慢性HCV感染。我们使用这种双重口服疗法治疗了一名患有HCV相关肝硬化且因慢性肾功能不全导致严重腿部水肿的患者。尽管在治疗的第一周血清丙氨酸氨基转移酶迅速升高，但抗病毒治疗得以继续，肝功能也自发恢复。治疗1个月后，血清HCV RNA持续检测不到，血清白蛋白水平逐渐升高。在整个治疗过程中，血清肌酐水平基本恢复正常，腿部水肿逐渐改善。联合治疗完成后，这些改善仍在持续。治疗结束后HCV RNA仍检测不到，且在12周时实现了持续病毒学应答。据报道，慢性HCV感染与肾功能不全有关，根除HCV可改善肾功能。DCV和ASV联合治疗对肾功能不全患者是安全的，可能是适合肾功能不全的慢性丙型肝炎患者的一种治疗方法。
