聚乙二醇干扰素联合利巴韦林治疗慢性丙型肝炎患者疗效及其影响因素分析

目的：观察聚乙二醇干扰素（PEG IFNα-2a）联合利巴韦林（RBV）治疗慢性丙型肝炎（CHC）患者的疗效及其影响因素。方法对331例慢性丙型肝炎患者予 PEG IFNα-2a（180μg/w 或135μg/w）联合利巴韦林（RBV）900~1200 mg/d 抗病毒治疗，疗程48～72 w，随访24 w；治疗前检测丙型肝炎病毒基因型，采用 PCR 法检测丙型肝炎病毒（HCV）RNA 水平及肝功能，以病毒学应答和生化学应答作为疗效的主要评价指标。结果在331例CHC 患者中，获得快速病毒学应答率（RVR）、早期病毒学应答率（EVR）和持续病毒学应答率（SVR）分别为65%（215/331）、94.9%（314/331）和84.9%（281/331）；对176例行基因分型，结果108例基因1型与68例非1型感染者SVR 分别为88.0%和79.4%，两组比较无明显差异；75例血清 HCV RNA 水平小于4×105 IU/ml 的患者 SVR 为93.3%，高于256例 HCV RNA 水平大于4×105 IU/ml 患者的82.4%（P〈0.05）；215例获得 RVR 的 CHC 患者的SVR 明显高于116例未获得 RVR 患者（92.6%对70.7%，x2=28.099，P=0.000），314例获得 EVR 患者的 SVR 也明显高于17例未获得 EVR 组（88.5%对17.6%，x2=63.194，P=0.000）；50例未获得 SVR 的 CHC 患者年龄和感染丙型肝炎病毒的时间分别为（46±15）岁和（14.8±8.0）年，显著大或长于281例获得 SVR 患者（38±13）岁和（11.5±7.7）年，P 均〈0.05]。结论聚乙二醇干扰素联合利巴韦林治疗慢性丙型肝炎疗效较好，预测临床疗效的关键因素是患者年龄、感染丙型肝炎的病程、治疗前 HCV RNA 水平及在治疗过程中能否及时获得 RVR 和 EVR。

Efficacy and influence factors of pegylated interferon alpha-2a plus ribavirin for treatment of patients with chronic hepatitis C

Objective To evaluate the efficacy and influence factors of pegylated interferon alpha-2a （Peg IFN alpha-2a） plus ribavirin （RBV） for treatment of patients with chronic hepatitis C. Methods Three hundred and thirty-one patients with chronic hepatitis C were treated with Peg IFN alpha-2a （180 μg/week or 135 μg/week） plus RBV （900 to 1200 mg/d） for 48 to 72 weeks, and all patients were followed up for 24 weeks after treatment. HCV genotypes,HCV RNA by PCR and liver function index were tested before and after therapy,re-spectively. Results Rapid virologic response （RVR）,early virologic response （EVR） and sustained virologic re-sponse （SVR） were 65%（215/331）,94.9% （314/331） and 84.9%（281/331）,respectively in this series of patients with CHC;HCV genotypes were obtained in 176 patients, and the SVR was 88.0% and 79.4% in 108 patients with HCV genotype-1 infection and 68 with non-genotype 1 infection,respectively,which did not differ statistically between the two groups;Higher SVR of 93.3% was obtained in 75 patients with baseline HCV RNA ≤4×105 IU/ml than 82.4% （P〈0.05） in 256 patients with 〉4×105 IU/ml;SVR in 215 patients having RVR was significantly higher than that in 116 patients having not （92.6% vs. 70.7%,x2=28.099,P=0.000）;Similarly,SVR in 314 patients having EVR was significantly higher than that in 17 patients having not （88.5% vs. 17.6%,x2=63.194,P=0.000）;The age of 50 patients with CHC who did not achieve SVR （46±15） years] was older than that of 281 patients who did （38±13） years,P〈0.05],and the duration of infection in patients who did not achieved SVR （14.8±8.0） years] was longer than that in patients who did （11.5±7.7） years,P〈0.05）. Conclusion Peginterferon alpha-2a plus ribavirin is effective in treatment of patients with CHC, and the efficacy is related to serum HCV RNA load at baseline, age of patients, disease course, and RVR or EVR at early stage of the regimen.