摘要
目的探讨干扰素治疗慢性丙型肝炎的快速病毒学应答（RVR）对疗效的预测及其相关因素。方法对139例慢性丙型肝炎患者，根据其临床特点，给予标准干扰素（IFN）或聚乙二醇干扰素（PEGIFN）治疗。IFN-α3～5MU隔日注射1次；PEG—IFNα-2a击者135～180μg，或PEG-IFNα-2b 50～80μg，每周注射1次。并根据患者的体质量给予600～1500mg／d的利巴韦林，在治疗的0、4、12周和以后每间隔12周、治疗结束后的24周进行HCVRNA含量检测，根据患者治疗过程中的病毒学应答情况给予24～72周的疗程，以持续病毒学应答（SVR）作为疗效的评判指标。根据资料不同采用并。检验或f检验。结果132例患者完成了全程观察，其中4例治疗无效（3．0％），12例复发（9．1％），获得SVR有116例（87．9％）。120例在治疗4周时检测了病毒学指标，101例（84．2％）获得了RVR，治疗前病毒载量为（5．883±1．246）培拷贝／ml，19例无RVR，治疗前病毒载量为（6．502±0．693）lg拷贝／ml，两组比较，t=2．15，P=0．034，差异有统计学意义。97例完成全程观察的RVR患者中，88例（90．7％）获得SVR，17例无RVR的患者，14（82．4％）例获得了SVR，X^2=0．371，P=0．543，差异无统计学意义。基因1型HCV感染患者的RVR为80．7％（46／57），非基因1型HCV感染患者的RVR率为92．6％（25／27），两组间比较，X^2=6．00，P=0．112，差异无统计学意义。初治患者的RVR率为87．8％，干扰素再治疗者的RVR率为65．0％，两组比较，X^2=4．651，P=0．031，差异有统计学意义。结论干扰素个体化抗病毒治疗慢性丙型肝炎，有较高的RVR获得率。RVR的获得与治疗前HCVRNA载量和患者是否为初次治疗相关，与基因型无关，RVR的获得可预测SVR的获得。
Objective To evaluate whether the rapid viral response （RVR） to combinational therapy with interferon and rabavirin can be used to predict the sustained viral response （SVR） in chronic hepatitis C patients. Methods According to their clinical characteristics, all patients in this study were given pegylated or conventional interferon injection and different dose of ribavirin according to their weight. Patients were injected Pegasys （pegierferon alpha-2a） 180μg or 135 jag once a week, or pegyintron 50-80μg once a week, or conventional interferon 3-5 MU every two days, in combination with a dose of 600-1500 mg/d ribavirin. The serum HCV RNA load was determined at 0, 4, 12 week, and then every 12 weeks. After the viral response obtained, the patients were treated for another 24-72 weeks and followed up 24 weeks. The main parameter to evaluate the efficacy was SVR rate. The influence factors associatied with rapid viral response were investigated. Results RVR was obtained at week 4 in 84.2% of the 120 patients. The HCV RNA baseline of RVR group was （5.883±1.246） lg copies/ml, which was significantly lower than that of the group without RVR [（6.502 ±0.693） lg copies/ml, t = 2.15, P = 0.034]. 97 patients with RVR who finished treatment and follow-up, 90.7% of these patients obtained SVR, but the SVR rate in patients （82.4%） without RVR was lower than that in patients with RVR （ X^2= 0.371, P = 0.543）. In this study, RVR rate was not associated with HCV genotype and the dose of interferon used. In the naive patients, the RVR to pegylated interferon was 87.8%, which was significantly higher than that in retreat patients （ X^2 = 4.651, P = 0.031）. Conclusions High RVR rate could be obtained in chronic hepatitis C patients treated combinationally with interferon and ribavirin. RVR rate is associated with the HCV RNA baseline load in both naive and retreat patients but not correlated to HCV genotype. RVR could predict the SVR..
出处
《中华肝脏病杂志》
CAS
CSCD
北大核心
2009年第7期497-500,共4页
Chinese Journal of Hepatology
关键词
肝炎
丙型
慢性
治疗
预测
干扰素类
病毒载量
Hepatitis C, chronic
Therapy
Forecasting
lnterferons
Viral load
