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慢性丙型肝炎患者直接作用抗病毒药物无干扰素治疗的健康相关生活质量和疲劳。

Health-related quality of life and fatigue in patients with chronic hepatitis C with therapy with direct-acting antivirals agents interferon-free.

机构信息

Department of Gastroenterology, University Federal of Juiz de Fora, Juiz de Fora, MG, Brasil.

出版信息

PLoS One. 2020 Aug 19;15(8):e0237005. doi: 10.1371/journal.pone.0237005. eCollection 2020.


DOI:10.1371/journal.pone.0237005
PMID:32813740
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7437906/
Abstract

INTRODUCTION: Interferon (IFN)-free regimens for the treatment of chronic hepatitis C have shown high rates of sustained virological response (SVR) and improved patient-reported outcomes (PROs). The aim of this study was to evaluate the health-related quality of life (HRQoL) and fatigue of patients with chronic hepatitis C (HCV) treated with IFN-free direct-acting antiviral (DAA) agents that achieved SVR following treatment and identify the predictive factors related to HRQoL. METHODS: Prospective cohort study that included patients with HCV treated with DAA who obtained an SVR. The patients answered three self-reported questionnaires (PROs): Short Form 36 (SF-36), the Chronic Liver Diseases Questionnaire (CLDQ), and the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) questionnaire at baseline, weeks 6 and 12 of treatment, and at 12 weeks after therapy. Patients were treated with DAA with or without ribavirin (RBV). The PRO scores were compared using analysis of variance (ANOVA). A comparison of PROs and serum hemoglobin levels was performed between the group that used ribavirin and the one that did not use ribavirin using the t student test. Predictive factors were calculated using a multiple linear regression model. RESULTS: Among the 113 patients selected, 105 presented an SVR and were included in the study, in which, 54% men, 80% genotype 1, 44% cirrhosis and 46% with RBV. At 12 weeks after the end of treatment, there was a significant improvement in the scores of the patient self-reports (PROs) when compared with baseline for the CLDQ (+10.52%, p<0.001), SF-36-Physical Summary (+19%, p<0.001), and FACIT (+17.34%, p<0.001). Patients who used RBV had worse PROs and serum hemoglobin levels compared to the group that did not use RBV (p<0,05). As predictors of worsening of the PROs we had the presence of diabetes mellitus, liver cirrhosis and HIV co-infected. CONCLUSION: Patients treated with IFN free regimens presents significant improvement in PROs. The presence of diabetes mellitus, cirrhosis, and HIV co-infected has a negative effect on HRQoL before, during and after treatment of hepatitis C. The addition of ribavirin to the antiviral regimens used compromises the HRQoL indexes during antiviral therapy.

摘要

简介:无干扰素方案治疗慢性丙型肝炎(HCV)已显示出高持续病毒学应答(SVR)率和改善患者报告的结局(PROs)。本研究旨在评估接受无干扰素直接作用抗病毒(DAA)药物治疗的慢性 HCV 患者的健康相关生活质量(HRQoL)和疲劳情况,这些患者在治疗后获得 SVR,并确定与 HRQoL 相关的预测因素。 方法:这是一项前瞻性队列研究,纳入了接受 DAA 治疗并获得 SVR 的 HCV 患者。患者在基线、治疗第 6 周和第 12 周以及治疗结束后 12 周时回答了三个自我报告问卷(PROs):健康调查简表 36 项(SF-36)、慢性肝病问卷(CLDQ)和慢性疾病治疗功能评估-疲劳(FACIT-F)问卷。患者接受了含或不含利巴韦林(RBV)的 DAA 治疗。采用方差分析(ANOVA)比较 PRO 评分。采用 t 检验比较使用和不使用利巴韦林的两组之间的 PRO 评分和血清血红蛋白水平。采用多元线性回归模型计算预测因素。 结果:在入选的 113 例患者中,有 105 例患者获得 SVR 并纳入研究,其中 54%为男性,80%为基因型 1,44%为肝硬化,46%使用 RBV。治疗结束后 12 周时,与基线相比,CLDQ(+10.52%,p<0.001)、SF-36-生理总分(+19%,p<0.001)和 FACIT(+17.34%,p<0.001)的患者自我报告(PROs)评分显著改善。与未使用利巴韦林的患者相比,使用利巴韦林的患者的 PROs 和血清血红蛋白水平更差(p<0.05)。我们发现,糖尿病、肝硬化和 HIV 合并感染是 PROs 恶化的预测因素。 结论:接受无干扰素方案治疗的患者在 PROs 方面有显著改善。糖尿病、肝硬化和 HIV 合并感染会对 HCV 治疗前、治疗中和治疗后的 HRQoL 产生负面影响。利巴韦林在抗病毒治疗期间会损害抗病毒治疗的 HRQoL 指标。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/96ef/7437906/ffaa922e311c/pone.0237005.g006.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/96ef/7437906/94ec9b96423f/pone.0237005.g003.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/96ef/7437906/73a31c072afd/pone.0237005.g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/96ef/7437906/ffaa922e311c/pone.0237005.g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/96ef/7437906/4547d56cf286/pone.0237005.g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/96ef/7437906/05b5e2cc676c/pone.0237005.g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/96ef/7437906/94ec9b96423f/pone.0237005.g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/96ef/7437906/510bfc38cf65/pone.0237005.g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/96ef/7437906/73a31c072afd/pone.0237005.g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/96ef/7437906/ffaa922e311c/pone.0237005.g006.jpg

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本文引用的文献

[1]
Early HCV viral kinetics under DAAs may optimize duration of therapy in patients with compensated cirrhosis.

Liver Int. 2018-12-28

[2]
French Patients with Hepatitis C Treated with Direct-Acting Antiviral Combinations: The Effect on Patient-Reported Outcomes.

Value Health. 2018-2-21

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