Tarao Kazuo, Nozaki Akito, Komatsu Hirokazu
Tarao's Gastroenterological Clinic, Yokohama, Japan.
Department of Gastroenterology, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan.
Case Rep Gastroenterol. 2021 Apr 27;15(1):436-442. doi: 10.1159/000511749. eCollection 2021 Jan-Apr.
Oral direct-acting antivirals (DAAs) are the main therapy for hepatitis C virus (HCV)-associated liver disease in Japan. Moreover, many DAAs include an indication for compensated liver cirrhosis. However, patients with decompensated HCV-associated cirrhosis have hitherto not been indicated for therapy with DAAs. Recently, a new DAA, sofosbuvir/velpatasvir (SOF/VEL), was indicated for decompensated HCV-associated cirrhotic patients. Actually, it has been shown to eradicate HCV in many cases. However, it is not clear whether hepatic encephalopathy, ascites, and pleural effusion in patients with decompensated HCV-associated cirrhosis disappear by SOF/VEL treatment. Recently, we encountered a decompensated HCV-associated cirrhosis patient who showed the disappearance of hepatic encephalopathy, ascites, and pleural effusion with marked improvement of serum ammonia level, albumin level, prothrombin time, and platelet count after the eradication of HCV by the administration of SOF/VEL. Her consciousness was cloudy and it took many hours for the preparation of each meal just before SOF/VEL treatment, but after the disappearance of HCV-RNA by the therapy, her consciousness became clear and she could prepare meals in a short time. This case suggests the possibility of improvement from decompensated HCV-associated liver cirrhosis to compensated liver cirrhosis with disappearance of hepatic encephalopathy, ascites, and pleural effusion by SOF/VEL therapy.
在日本，口服直接抗病毒药物（DAAs）是丙型肝炎病毒（HCV）相关肝病的主要治疗方法。此外，许多DAAs都有适用于代偿期肝硬化的适应症。然而，失代偿期HCV相关肝硬化患者迄今尚未被列为DAAs治疗的适应症。最近，一种新的DAA，索磷布韦/维帕他韦（SOF/VEL），被批准用于失代偿期HCV相关肝硬化患者。实际上，在许多病例中已证明它能根除HCV。然而，尚不清楚失代偿期HCV相关肝硬化患者的肝性脑病、腹水和胸腔积液是否会通过SOF/VEL治疗而消失。最近，我们遇到了一名失代偿期HCV相关肝硬化患者，在通过服用SOF/VEL根除HCV后，肝性脑病、腹水和胸腔积液消失，血清氨水平、白蛋白水平、凝血酶原时间和血小板计数显著改善。她之前意识模糊，在接受SOF/VEL治疗前每餐准备都要花好几个小时，但在治疗使HCV-RNA消失后，她的意识变得清晰，并且能在短时间内准备好饭菜。该病例提示，通过SOF/VEL治疗，失代偿期HCV相关肝硬化有可能改善为代偿期肝硬化，同时肝性脑病、腹水和胸腔积液消失。
