| Objective: Observe the impact of antiviral therapy and antifibrosis therapy on the progress of LSM in patients with chronic hepatitis C(CHC),with a view to providing a reference for the clinical standardization of chronic hepatitis C patients.Methods: Retrospective study of patients with chronic hepatitis C from May 2015 to June 2019 in the outpatient department of infectious diseases in the First Affiliated Hospital of Guangxi Medical University,collect general clinical data,chronic hepatitis C virus load,genotype,liver function,liver stiffness measurement value(LSM value),liver B-ultrasound,antiviral programs,anti-fibrotic drugs,etc.Analysis from two aspects,the first aspect analyzes the effect of antiviral therapy on LSM values,55 patients with chronic hepatitis C who obtained sustained virological response were divided into two groups according to different antiviral programs:44 patients treated with direct antiviral agents(DAAs)were in the DAAs treatment group(DAAs group),of these,19 patients in the sofosbuvir / vipatavir group(group A),13 patients in the sofosbuvir combined dalatavir group(group B),and 12 patients in the sofosbuvir combined ribavirin group(group C);and 11 patients treated with long-acting interferon combined with ribavirin were in the interferon treatment group(interferon group).In addition,14 patients who were not treated with antiviral drugs were used as a control group(non-antiviral control group).Longitudinal and lateral analysis to compare liver stiffness measurement values(LSM values)of different groups of patients in different periods of treatment: at baseline,24 weeks and 48 weeks after treatment.The second aspect analyzes the effect of anti-fibrosis treatment on LSM values:A total of 75 patients with chronic hepatitis C who had advanced liver fibrosis with sustained virological response were collected,among them,42 cases were treated with anti-liver fibrosis drugs,which were divided into two groups according to the different anti-fibrosis drugs:20 patients with advanced liver fibrosis treated with Fuzheng Huayu tablets / capsules were in Fuzheng Huayu tablets / capsules treatment group(Fuzheng Huayu group),22 patients with advanced liver fibrosis treated with Dahuang Zhechong Pill were in Dahuang Zhechong Pill treatment group(Dahuang Zhechong Pill group),another 33 patients with advanced liver fibrosis who were not treated with any hepatitis-related drugs were used as controls(control group),the liver stiffness measurement values(LSM values)of the three groups of patients at baseline,24 weeks,48 weeks,and 72 weeks were analyzed and compared.Results:(1)Longitudinal comparison of LSM values of antiviral therapy in patients with chronic hepatitis C: compared with the baseline,the LSM values of group A(sofosbuvir / vipatavir),group B(sofosbuvir / dalatavir),group C(sofosbuvir /ribavirin)and interferon group all decreased at 24 weeks,differences were statistically significant(Z values were 3.702,3.181,2.943,2.934,P values were0.000,0.001,0.003,0.003).compared with 24 weeks,the LSM values of group A,group B and interferon group all decreased at 48 weeks,differences were statistically significant(Z values were 3.824,2.447,2.805,P values were 0.000,0.014,0.005).compared with 24 weeks,there was no significant change in LSM value at 48 weeks in group C,the difference was not statistically significant(Z=0.889,P=0.374).(2)Horizontal comparison of LSM values of antiviral therapy in patients with chronic hepatitis C: compared with the change value of LSM in DAAs group,interferon group and non-antivirus group,differences were statistically significant at 24 weeks(Z value were-3.843,-2.847,P value were 0.000,0.004).compared with the change value of LSM in DAAs group,interferon group and non-antivirus group,differences were statistically significant at 48 weeks(Z value were-5.333,-3.996,P values were 0.000).comparing the changes in LSM between the DAAs group and the interferon group,the differences were not statistically significant at 24 and 48 weeks(Z values were-0.263 and-0.242,and P values were 0.793 and 0.809).(3)Longitudinal comparison of LSM values in patients with chronic hepatitis C without antiviral therapy: compared with the baseline,the non-antiviral group showed no significant change in LSM value at 24 weeks,and the difference was not statistically significant(Z=0.754,P=0.451),the LSM value increased in the non-antiviral group at 48 weeks,the difference was statistically significant(Z=2.103,P=0.035).(4)Comparison of LSM in patients with advanced liver fibrosis taking Fuzheng Huayu tablets / capsules: compared with the baseline,the LSM value of Fuzheng Huayu group decreased significantly at 24 weeks,the difference was statistically significant(t=12.259,P=0.000).compared with 24 weeks,the LSM value of Fuzheng Huayu group decreased at 48 weeks,the difference was statistically significant(t=8.721,P=0.000).compared with 48 weeks,Fuzheng Huayu group still decreased at 72 weeks,but it was slower than before,the difference was statistically significant(t=2.871,P=0.010).compared with the LSM change value of the control group,the Fuzheng Huayu group had statistically significant differences at 24 weeks,48 weeks,and 72 weeks(t values were 12.346,16.161,16.881,P values were 0.000).(5)Comparison of LSM in patients with advanced liver fibrosis taking Dahuang Yuanchong Pill: compared with the baseline,the LSM value of the Dahuang Zhechong Pill group did not decrease significantly at 24 weeks,and the difference was not statistically significant(t=1.516,P=0.144).compared with 24 weeks,the LSM value of Dahuang Zhechong Pill group decreased significantly at 48 weeks,the difference was statistically significant(t=10.086,P=0.000).compared with 48 weeks,the LSM value of Dahuang Zhechong Pill group decreased significantly at 72 weeks,the difference was statistically significant(t=11.246,P=0.000).compared with the LSM change value of the control group,Dahuang Zhechong Pill group had statistically significant differences at 24 weeks,48 weeks,and 72 weeks(t values were 2.424,12.108,17.707,P values were 0.020,0.000,0.000).comparing the LSM change value of Fuzheng Huayu group and Dahuang Zhechong Pill group at 72 weeks,the difference was not statistically significant(t=1.092,P=0.282).(6)Comparison of LSM in patients with advanced liver fibrosis without anti-fibrosis therapy: compared with the baseline,the control group had no significant change in LSM value at 24 weeks,and the difference was not statistically significant(t=-1.982,P=0.056).compared with 24 weeks,the LSM value of the control group increased at 48 weeks,the difference was statistically significant(t=-4.896,P=0.000).compared with 48 weeks,the LSM value of the control group increased at 72 weeks,the difference was statistically significant(t=-5.535,P=0.000).Of the 33 patients in the control group,there were 7patients whose LSM value had progressed from baseline,and the progress was very large.The remaining 26 patients in the control group had no progress in LSM value.The number of progressive cases accounted for 21.2% of the total number of cases in the control group(7/33).Conclusion:(1)For patients with HCV RNA positive chronic hepatitis C,whether DAAs or interferon antiviral therapy achieves a sustained virological response,the liver stiffness measurement value(LSM)can be significantly improved,without antiviral therapy,the liver stiffness measurement value(LSM)does not improve,and may even progress,and there seems to be no significant difference in the degree of improvement of liver stiffness measurement value(LSM)between DAAs and interferon.(2)For CHC patients with advanced liver fibrosis who have achieved a sustained virological response,Fuzheng Huayu tablets / capsules and Dahuang Zhechong Pill anti-fibrosis treatment have certain improvement effects on liver stiffness measurement value(LSM),and each of the two drugs has its own characteristics.Without anti-fibrosis treatment,there is no improvement in liver stiffness measurement value(LSM),and some patients may even progress over time. |
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