Kev kwv yees qhov tshwm sim ntawm kev kho mob nrog cov tshuaj tua kab mob ncaj qha rau lub raum ua haujlwm ntawm cov tib neeg uas muaj kab mob siab C Ⅱ

Cov txiaj ntsig

Cov yam ntxwv piav qhia ntawm lub hauv paus rau txhua pawg tau nthuav tawm hauvTable 1. Cov yam ntxwv piav qhia stratified los ntawm kev kho mob nrog DAA tau nthuav tawm hauvS5 Tab. Cohort 1 suav nrog 1442 tus neeg mob tsim nyog nrognormalize lub raum ua haujlwm. Hauv pab pawg no, qhov nruab nrab [IQR] hnub nyoog yog 49 [35, 57] xyoo, qhov nruab nrab [IQR] eGFR yog 105 ml / min / 1.73m2 [98, 114] thiab 1022 (71%) yog txiv neej. Nyob rau hauv lub hauv paus, 53% ntawm cov neeg mob muajntshav siabthiab 14% muajntshav qab zib. Hauvqeb 1,927 (64%) cov neeg mob tau pib DAAs thaum lub sijhawm ua raws thiab ntawm cov no, 538 (58%) tau pib hauv 3 lub hlis ntawm qhov pib. Ntawm 927 tus neeg mob uas pib DAAs, 822 (89%) muaj aTom qab kho HCV-RNAntsuas thiab 792 ntawm 822 (96%) tau ua tiav SVR txhais tias yog qhov tsis paub tseeb HCV-RNA.

Table 2. Kev kwv yees ua rau muaj txiaj ntsig ntawm DAA kev pib cuam tshuam ntawm lub raum kev ua haujlwm stratified los ntawm lub raum ua haujlwm hauv qab.

Hauv pawg 1, 101 (7%) cov tib neeg tau tsimTheem 3 CKDCov xwm txheej thiab 13 tuag thaum 3,048 tus neeg-xyoo ntawm kev soj ntsuam. Raws li tau nthuav tawm hauv Table 2, qhov hloov kho kwv yees 2- xyoo kev pheej hmoo (95% CI) ntawm mus txog theem 3 CKD yog 5% (3%, 6%) thiab 5% (4%, 8%) raws li DAA pib thiab tsis muaj DAA pib, raws li (kev pheej hmoo sib txawv -1% (-3), 2%)).

Pawg 2 suav nrog 733 tus neeg mob tsim nyog nrogCKD Theem 2–4ntawm lub hauv paus. Hauv pab pawg no, cov hnub nyoog nruab nrab [IQR] hnub nyoog yog 59 [53, 64] xyoo, qhov nruab nrab [IQR] eGFR yog 76 [64, 83] ml / min / 1.73m2 thiab 435 (59%) yog txiv neej. Hauv qhov pib, 68% muaj ntshav siab thiab 26% muaj ntshav qab zib. Hauv pawg 2, 514 (70%) cov neeg mob pib DAA thaum taug qab thiab ntawm cov no, 316 (61%) tau pib DAA hauv 3 lub hlis ntawm lub hauv paus. Ntawm 514 leej twg pib DAA, 494 (96%) tau ntsuas tom qab kho HCV-RNA, thiab 481 ntawm 494 (97%) tau ua tiav SVR txhais tias yog HCV-RNA tsis tuaj yeem kuaj pom.

Hauv pawg 2, qhov pom tau hais tias (tus qauv sib txawv, SD) hloov los ntawm cov kab hauv qab eGFR yog 0 (16) ml/min/1.73m2 . Qhov ntsuas ntsuas qhov ntsuas (95% CI) hloov los ntawm lub hauv paus hauv eGFR yog 0 (-3, 2) ml/min/1.73m2 thiab 3 (-1, 8) ml/min/ 1.73m2 raws li DAA pib thiab tsis muaj DAA pib, feem. Piv rau tsis muaj DAA pib, qhov txawv nruab nrab yog -3 (-8, 2) ml/ min/1.73m2 nyob rau hauv DAA pib. Muaj 14 tus neeg tuag thaum lub sijhawm taug qab hauv pawg 2.

Results of subgroup analyses are presented in S6–S8 Tables. Individuals with diabetes, with hypertension, or aged >45 xyoo muaj qhov tshwm sim ntau dua ntawm CKD Theem 3 (cohort 1) thiab eGFR poob sai dua (cohort 2) ntawm 2 xyoos tom qab pib piv rau lawv cov neeg tsis muaj ntshav qab zib, tsis muaj ntshav siab, lossis hnub nyoog 45 xyoo. Kev kwv yees cov txiaj ntsig tau zoo ib yam li cov hauv kev tsom xam, txawm hais tias muaj qhov qis dua vim muaj cov qauv me me. Cov pab pawg ntawm cov neeg mob hnub nyoog 45 xyoo hauv pawg 2 muaj cov neeg mob tsawg dhau (N=78) tso cai rau kev kwv yees.

Cov txiaj ntsig los ntawm kev txheeb xyuas qhov kev xav tau zoo sib xws nrog cov txiaj ntsig tseem ceeb rau ob pawg (S6 thiab S7 Figs). Kev faib tawm ntawm lub sijhawm sib txawv txhais tau tias kwv yees los ntawm peb cov qauv zoo ib yam li cov kev pom zoo (S3 thiab S4 Figs)

Kev sib tham

Peb kwv yees qhov tshwm sim ntawm kev pib ua piv txwv tsis pib kho DAA ntawm lub raum ua haujlwm hauv ob pawg ntawm cov neeg mob uas muaj tus kab mob HCV: ib qho uas muaj lub raum ua haujlwm (cohort 1) thiab ib qho nrog cov hauv paus.CKD Theem 2–4(nqe 2). Rau cov neeg uas muaj lub raum ua haujlwm ntawm lub hauv paus, peb pom tsis muaj qhov sib txawv ntawm qhov kev pheej hmoo ntawm mus txog theem 3 CKD tau tag nrho cov neeg mob pib kho DAA piv rau txhua tus neeg mob tsis tau pib kho DAA. Ib yam li ntawd, rau cov uas muajCKD Theem 2–4ntawm lub hauv paus, peb pom tsis muaj qhov sib txawv hauv 2- xyoo tom qab hloov pauv hauv eGFR muaj tag nrho cov tsis muaj cov neeg mob pib DAA. Cov txiaj ntsig no tau muaj txiaj ntsig zoo rau ntau qhov kev soj ntsuam rhiab heev uas muaj ntau yam kev txiav txim siab analytic thiab qauv specifications. Tsis tas li ntawd, hauv peb qhov kev ntsuam xyuas theem nrab, peb tau soj ntsuam cov neeg mob cov pab pawg uas yuav tau txais txiaj ntsig tshwj xeeb los ntawm kev kho mob thiab pom tias tsis muaj txiaj ntsig ntawm DAAs ntawm lub raum ua haujlwm. Tag nrho cov kev tshawb pom no qhia tias kev kho mob nrog DAA rau kev kis tus kab mob HCV tsis ua rau lub raum ua haujlwm tau zoo dua li 2- xyoo.

Kev soj ntsuam yav dhau los tau kwv yees qhov kev sib koom ua ke ntawm DAA kev kho mob thiab eGFR tiam sis. Tshwj xeeb, Driedger et al. qhia tias tsis muaj qhov hloov pauv hauv lub raum ua haujlwm ua ntej thiab tom qab DAA pib [17]. Hauv lwm txoj kev tshawb fawb, Medeiros li al. pom tsis muaj kev koom tes ntawm sofosbuvir-raws li DAA kev tswj hwm thiab eGFR ntawm ib pawg neeg mob uas muaj cov kab hauv qabeGFR<45 ml/min/1.73m2 but observed improvements in renal function among those with eGFR>45 ml/min/1.73m2 [18]. An observational study by Sise et al. compared eGFR slope one year before and one year after DAA initiation and found no difference among those with baseline eGFR>60 ml / min / 1.73m2 tab sis qhia txog kev txhim kho ntawm cov neeg uas muaj eGFR<60 ml/min/1.73m2 [16]. In addition, in a retrospective cohort study of patients treated with ledipasvir/sofosbuvir for HCV genotype 1b, Okubo et al. reported no changes in eGFR from pre-treatment to 12 weeks post-treatment among those withCKD Theem 3[10]. Thaum kawg, kev soj ntsuam yav tom ntej nrog kev ntsuas eGFR biannual pom tsis muaj qhov sib txawv tseem ceeb hauv eGFR evolution ntawm DAA-kho cov neeg uas tau ua thiab tsis ua tiav SVR [19]. Tag nrho cov kev tshawb fawb no piv rau lub raum ua haujlwm ua ntej thiab tom qab kev kho DAA, yog li ntawd, lawv tsuas yog tshuaj xyuas cov neeg mob uas tau txais kev kho DAA. Thaum txoj hauv kev no tso cai rau kev tswj hwm cov ntsiab lus tsis txaus ntseeg, uas cov neeg mob ua raws li lawv tus kheej kev tswj hwm, cov kev kwv yees no tuaj yeem cuam tshuam yog tias cov neeg mob uas tau txais kev kho DAA muaj qhov ua tsis zoo (lossis zoo dua) lub raum ua haujlwm dua li cov uas tsis [9, 40, 41] . Hauv qhov sib piv, peb tau tsim peb txoj kev tshawb fawb kom suav nrog txhua tus neeg mob tsim nyog tau txais kev kho DAA thiab peb tau hloov kho rau cov neeg muaj peev xwm confounders. Txawm hais tias muaj kev sib txawv ntawm kev tsim qauv, peb cov txiaj ntsig tsis tsuas yog ua raws li qhov tsis muaj kev sib koom ua ke ntawm qhov tseebkho nrog DAAsthiablub raum ua haujlwmnyob rau hauv cov ntaub ntawv tab sis kuj yog generalizable rau tag nrho cov neeg mob tsim nyog tau txais DAAs.

Peb txoj kev kawm muaj lub zog tseem ceeb. Peb tau siv cov ntaub ntawv ntev los ntawm lub tsev kho mob hauv nroog kev nyab xeeb nrog kev kuaj HCV tseem ceeb thiab kev tshuaj ntsuam xyuas, uas tso cai rau peb suav nrog cov neeg mob sib txawv. Peb tau txheeb xyuas qhov kev nplua nuj ntawm cov ntaub ntawv hauv ntiaj teb no nrog cov txheej txheem ua kom pom tseeb uas tau kho meej meej rau lub sijhawm sib txawv ntawm qhov tsis sib haum xeeb thiab kev xaiv tsis ncaj ncees. Lub sijhawm sib txawv ntawm qhov tsis sib haum xeeb yog qhov tseem ceeb rau qhov kev kawm no: kev ntsuas siab ua haujlwm siab thiab muaj qee yam covariates qhia tias xav tau kev kho mob ntau dua, thiab kev kho mob ua kom lub siab ua haujlwm [12, 13]. Kev xaiv tsis ncaj ncees kuj tseem muaj, uas cov neeg mob nrog CKD ntawm lub hauv paus pib muaj kev ntsuas tom qab eGFR ntau dua li cov neeg uas muaj lub raum ua haujlwm [32]. Peb hais txog ob qho teeb meem los ntawm kev hloov kho rau cov kev hloov pauv uas cuam tshuam nrog rau lub raum kev ua haujlwm, suav nrog kev kho kom meej meej rau lub raum saib xyuas zaus. Los ntawm stratify cov neeg mob mus rau hauv pawg raws li lub hauv paus raum kev ua haujlwm, peb tsom los txo qhov cuam tshuam ntawm kev xaiv tsis ncaj ncees rau peb cov txiaj ntsig. Peb txoj kev tshawb fawb qhia meej meej txog qhov yuav tshwm sim yog txhua tus neeg mob pib tiv thaiv tsis tau pib DAA, uas txawv ntawm, tab sis ntxiv, cov kev tshawb fawb yav dhau los uas piv rau lub raum ua haujlwm ua ntej thiab tom qab kev kho DAA. Raws li nws yuav ua tsis ncaj ncees los ua qhov kev sim ntsuas randomized (RCT) uas muab qee tus neeg mob rauKev kho HCVthiab lwm yam tsis yog, peb txoj kev tshawb fawb tau zoo li kev sib raug zoo raws li qhov ua tau rau RCT thiab, tshwj xeeb tshaj yog, ua rau peb tawm tswv yim txog qhov ua rau, tsis yog kev koom tes xwb.

Peb txoj kev kawm kuj muaj ob peb yam kev txwv. Ua ntej, peb txoj kev cia siab rau qhov kev xav ntawm tsis muaj qhov seem ntawm qhov tsis sib haum xeeb, tab sis peb yuav tsis tau ntes tag nrho cov yam ntxwv tsis meej pem. Txawm li cas los xij, peb cais ob pawg neeg sib txawv nrog lub raum ua haujlwm sib txawv thiab kev kho mob thiab pej xeem cov yam ntxwv, thiab, yog li, lawv kuj muaj cov qauv sib txawv. Peb pom cov nyhuv null hauv ob pawg, yog li ntawd, nws txhawb peb cov lus xaus. Qhov thib ob, kev siv rov qab los ntawm EHRs yog qhov ua yuam kev: tej zaum peb yuav tsis tuag, kev kho HCV, lossis

Kev ntsuas ntsuas tau ua nyob sab nraud ntawm lub tsev kho mob. Qhov thib peb, peb siv cov ntawv sau tshuaj kom paub tseeb tias qhov pib kho DAA, tab sis peb tsis muaj cov ntaub ntawv ntawm kev ua raws li cov tshuaj. Cov nqi kho mob tiav rau DAAs tsawg li 68% tau tshaj tawm rau cov neeg mob HCV [11]. Txawm li cas los xij, kev tshawb fawb tsis ntev los no hauv cov neeg sib tshooj ntawm Boston Medical Center pom, los ntawm kev sib piv daim ntawv tshuaj xyuas DAA kev ua raws li EHR cov ntaub ntawv sau tshuaj, tsuas yog 7% ntawm cov tib neeg tau sau DAAs tsis tau pib kho [42]. Plaub, vim tias qhov eGFR siab heev hauv peb cov qauv, peb siv lub hauv paus eGFR txiav tawm ntawm 90 ml / min / 1.73m2 . Qhov kev txiav tawm rau kev kho mob tseem ceeb CKD yog 60 ml / min / 1.73m2 , thiab yog li cov kev tshawb fawb yav tom ntej nrog cov qauv loj dua thiab / lossis ntau dua cov neeg mob lub raum tsis zoo yuav tsum rov ua qhov kev tshawb fawb no nrog kev txiav tawm nruj dua [21]. Thaum kawg, feem coob ntawm cov tib neeg uas pib kho DAA tau txais cov tshuaj sofosbu vir-muaj cov txheej txheem, raws li kev kho DAA hauv Tebchaws Meskas thaum lub sijhawm kawm. Kev kawm yav tom ntej nrog cov ntaub ntawv loj dua, tej zaum cov ntaub ntawv sib sau thoob plaws cov chaw kho mob, tuaj yeem saib cov txiaj ntsig ntawm DAA tshwj xeeb ua ke ntawm lub raum ua haujlwm [20].

Txawm hais tias cov kev txwv no, peb cov txiaj ntsig muaj qhov cuam tshuam tseem ceeb rau kev saib xyuas lub raum ntawm cov neeg mob kho nrog DAA. Qhov zaus ntawm kev saib xyuas lub raum yuav tsum nyob zoo ib yam tom qab kev kho mob nrog DAA raws li nws tau ua dhau los rau cov neeg muaj thiab tsis muaj lub raum tsis zoo. Raws li kab mob raum: Txhim kho Cov Txheej Txheem Thoob Ntiaj Teb, qhov no txhais tau tias tsawg kawg ib xyoos ib zaug saib xyuas eGFR rau cov neeg uas lub raum ua haujlwm tsis zoo thiab 1 txog 4+ zaug hauv ib xyoos rau cov neeg muaj CKD, nyob ntawm qhov hnyav [21]. Peb txoj kev tshawb fawb qhia tias DAAs yuav tsis yog nephrotoxic thiab qhov kev tshem tawm HCV yuav tsis rov qab ua haujlwm rau lub raum, tab sis kev tshawb fawb yav tom ntej yuav tsum ua haujlwm txuas ntxiv kom paub meej cov kev sib raug zoo no. Hauv kev xaus, peb siv cov txheej txheem muaj zog ua ke nrog cov ntaub ntawv nplua nuj thiab pom tsis muaj qhov cuam tshuam ntawm DAAkev kho mob raum ua haujlwm.

Cov ntaub ntawv

1. Barsoum RS, William EA, Khalil SS. Kab mob siab C thiab kab mob raum: Cov lus piav qhia. J Adv Res. 2017; 8(2):113–130. https://doi.org/10.1016/j.jare.2016.07.004 PMID: 28149647 ib

2. Tsui JI, Vittinghoff E, Shlipak MG, Bertenthal D, Inadomi J, Rodriguez RA, et al. Kev sib koom ua ke ntawm kab mob siab C seropositivity nrog kev pheej hmoo ntau ntxiv rau kev tsim kab mob raum kawg. Arch Intern Med. 2007; 167 (12): 1271–1276. https://doi.org/10.1001/archinte.167.12.1271 PMID: 17592100 ib

3. Molnar MZ, Alhourani HM, Wall BM, Lu JL, Streja E, Kalantar-Zadeh K, et al. Lub koom haum ntawm kab mob siab C kab mob nrog qhov tshwm sim thiab kev loj hlob ntawm cov kab mob raum ntev nyob rau hauv ib pawg loj ntawm US qub tub rog. Hepatology. 2015; 61 (5): 1495–1502. https://doi.org/10.1002/hep.27664 PMID: 25529816 ib

4. Qhov tseeb Negro F. thiab cov ntawv tseeb ntawm HCV thiab comorbidities: Steatosis, ntshav qab zib mellitus, thiab kab mob plawv. J Hepatol. 2014; 61 (1 Suppl): S69–S78. https://doi.org/10.1016/j.jhep.2014.08.003 PMID: 25443347

5. Satapathy SK, Lingisetty CS, Williams S. Muaj ntau dua ntawm cov kab mob raum ntev thiab lub raum kom muaj sia nyob luv dua hauv cov neeg mob uas muaj tus kab mob siab C ntev. Hepatol Int. 2012; 6(1):369–378. https://doi. org/10.1007/s12072-011-9284-9 PMID: 21698519

6. Su FH, Su CT, Chang SN, Chen PC, Sung FC, Lin CC, et al. Kev sib koom tes ntawm tus kab mob siab C nrog kev pheej hmoo ntawm ESRD: Kev tshawb fawb txog pej xeem. Am J Raum Dis. 2012; 60(4):553–560. https://doi.org/10. 1053/j.ajkd.2012.04.003 PMID: 22554802 PAB

7. Lee JJ, Lin MY, Chang JS, Hung CC, Chang JM, Chen HC, et al. Tus kab mob siab C ua rau muaj kev pheej hmoo ntawm kev tsim cov kab mob raum raum kawg uas siv cov kev pheej hmoo sib tw. PLoS Ib. 2014; 9 (6): e100790. https://doi.org/10.1371/journal.pone.0100790 PMID: 24971499 ib

8. US Department of Health thiab Human Services, Food and Drug Administration, Center for Drug Evaluation and Research. Tus kab mob siab C ntev: Tsim cov tshuaj tiv thaiv kab mob ncaj qha rau kev kho mob rau kev lag luam. Tsab ntawv xov xwm no tshwm sim thawj zaug https://www.fda.gov/regulatory-information/search-fda-guidance documents/chronic-hepatitis-c-virus-infection-developing-direct-acting-antiviral-drugs-treatment guidance. Kho tshiab 2017. Accessed July, 2021.

9. Trooskin SB, Reynolds H, Kostman JR. Kev nkag mus rau cov tshuaj tshiab kab mob siab C uas kim heev: tshuaj, nyiaj txiag, thiab kev tawm tswv yim. Clin Infect Dis. 2015; 61 (12): 1825–1830. https://doi.org/10.1093/cid/civ677 PMID: 26270682 ib

10. Okubo T, Atsukawa M, Tsubota A, Toyoda H, Shimada N, Abe H, et al. Kev ua tau zoo thiab kev nyab xeeb ntawm ledipasvir / sofosbuvir rau genotype 1b chronic hepatitis C cov neeg mob uas muaj lub raum tsis zoo. Hepatol Int. 2018 Peb Hlis; 12(2): 133–142. https://doi.org/10.1007/s12072-018-9859-9 PMID: 29600429

11. Butt AA, Ren Y, Puenpatom A, Arduino JM, Kumar R, Abou-Samra AB. Kev ua tau zoo, kev kho tiav thiab kev nyab xeeb ntawm sofosbuvir / ledipasvir thiab paritaprevir / ritonavir / ombitasvir + dasabuvir hauv cov neeg mob uas mob raum: kev tshawb fawb ARCHIVES. Aliment Pharmacol Ther. Lub Xya Hli 2018; 48(1):35–43. https://doi.org/10.1111/apt.14799 PMID: 29797514 ib

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