聚乙二醇干扰素α-2a 联合利巴韦林治疗基因1b 型慢性丙型肝炎临床观察

目的：观察聚乙二醇干扰素α-2a 联合利巴韦林治疗基因1b 型慢性丙型肝炎（CHC）的疗效及不良反应。方法40例基因1b 型 CHC 患者应用聚乙二醇干扰素α-2a 联合利巴韦林治疗,疗程48周,随访24周,观察病毒学应答情况及药物不良反应。结果获得快速病毒学应答（RVR）、完全早期病毒学应答（cEVR）、治疗结束时病毒学应答（ETVR）和持续病毒学应答（SVR）比例分别为65．0％、82．5％、90．0％、82．5％,获得 RVR 者均获得 SVR;合并脂肪肝者获得 SVR 的比例低于无脂肪肝者（P ＜0．05）;治疗过程中聚乙二醇干扰素α-2a 减量者8例,利巴韦林减量者6例。结论聚乙二醇干扰素α-2a 联合利巴韦林治疗基因1b 型 CHC 疗效良好;合并脂肪肝患者疗效低于无脂肪肝患者;治疗中不良反应普遍,但均能耐受。     

聚乙二醇干扰素α-2a联合利巴韦林治疗老年慢性丙型肝炎的疗效和安全性

目的分析聚乙二醇干扰素（PEG—IFN）α-2a联合利巴韦林治疗老年慢性丙型肝炎（CHC）的疗效和安全性。方法老年CHC患者（〉t60岁）（N：16）与中青年CHC患者（〈60岁）（N=46）接受PEG—IFNα-2a 180μg／周,利巴韦林800—1000mg／d联合治疗。比较两组患者在基线、病毒应答和不良反应发生率等差异。结果老年患者中性粒细胞减少症和血小板减少症的发生率显著高于中青年患者[（P=0．044,OR（95％CI）=3．264（1．005～10．599）;P=0,000,OR（95％CI）=2．875（1．935-4．271）]。两组患者SVR率差异无统计学意义（P=0．131）。单因素分析结果提示CHC患者年龄与SVR率无明显关联。结论PEG—IFN α-2a联合利巴韦林治疗老年CHC是安全有效的。     

慢性丙型肝炎干扰素治疗后复发患者的干扰素再治疗

目的探讨干扰素(IFN)治疗后复发的慢性丙型肝炎患者对IFN再治疗的应答情况及影响因素。方法对聚乙二醇化干扰素(PEG-IFN)α-2a与重组人干扰素(CIFN)α-2a治疗中国慢性丙型肝炎患者疗效与安全性的随机、开放、多中心对照研究中的6O例干扰素治疗后复发患者的再治疗进行回顾性研究。其中PEG-IFN α-2a组35例和CIFN α-2a组25例,以持续病毒学应答(SVR)作为疗效的主要评价指标,分析HCV RNA载量、基因型、药物种类对IFN疗效的影响。结果 60例复发患者用IFN再治疗后,55．00％取得治疗结束时的病毒学应答(ETVR),35．00％取得SVR;其中PEG-IFN α-2a组74.29％取得ETVR,显著高于CIFN α-2a组(28．00％),P<0．01; PEG-IFN α-2a组45．71％取得SVR,高于CIFN α-2a组(20．00％), P>0．05;病毒载量高、低组间的ETVR、SVR的差异无统计学意义;对于HCV基因1型感染患者,PEG- IFN α-2a的ETVR(75．00％)和SVR(45．83％)均显著高于CIFN α-2a组(分别为22．22％和11．11％), P相似文献   

聚乙二醇干扰素仪-2α／2b联合利巴韦林复治慢性丙型肝炎患者的疗效观察

目的探讨聚乙二醇干扰素α（PEG-IFNα）联合利巴韦林治疗复发慢性丙型肝炎（CHC）患者的应答情况及影响因素。方法 30例经IFN-α或PEG-IFNα标准RGT治疗后复发的CHC患者,均用PEG-IFNα-2a（180μg）或PEG-IFNα-2b（1.5μg/kg）联合利巴韦林（900 mg/d）再治疗,基因1型治疗48周,非基因1型治疗24周,停药随访24周,分析病毒基因型、基线HCV RNA载量、初治药物种类对联合治疗疗效的影响。结果 30例复发患者经联合再治疗后,24例（80%）获得持续病毒学应答（SVR）。18例低病毒载量（HCV RNA≤105拷贝/ml）患者中,17例（94.4%）获得SVR,与高病毒载量组（58.3%）差异有统计学意义（P=0.026）。基因1型组18例,其中14例（77.8%）获得SVR,与非基因1型组（83.3%）差异无统计学意义（P=1.000）。初治应用PEG-IFNα联合利巴韦林抗病毒的患者17例,其中13例（76.5%）经再治疗后获得SVR,与初治应用IFN-α抗病毒组（84.6%）无明显差异（P=0.672）。结论 PEG-IFNα联合利巴韦林治疗复发CHC患者的疗效较好。基线病毒载量高,再治疗效果差;病毒基因型及初治所采用的IFN类型与再治疗的疗效无显著相关性。     

聚乙二醇干扰素-α-2b联合利巴韦林治疗慢性丙型肝炎患者的长期病毒学应答北大核心CSCD

聚乙二醇干扰素α（peg—IFN—α）联合利巴韦林（RBV）治疗慢性丙型肝炎（chronic hepatitis virus C,CHC）结束后随访24周,患者血HCVRNA阴性可认为获得了持续病毒学应答（sustained virologic response,SVR）。     

对治疗无应答的慢性丙型肝炎处理研究进展

近10年来慢性丙型肝炎（CHC）的治疗取得了较大的进展，从最初的单用α干扰素治疗发展为α干扰素与利巴韦林联合治疗，到近几年来提倡采用聚乙二醇化（Peg）干扰素α-2a或2b加上利巴韦林治疗，使得持久病毒应答率（SVR）有了很大的提高。目前认为Peg干扰素α-2a或2b联合利巴韦林治疗是最有效的抗丙型肝炎病毒（HCV）的治疗方案，其次是普通α干扰素或复合干扰素与利巴韦林联合疗法，效果均优于单用α干扰素。     

芪参二莲汤加聚乙二醇干扰素α-2a联合利巴韦林治疗1b型慢性丙型肝炎疗效观察

目的：观察探讨PEG IFN（聚乙二醇干扰素）α-2a联合利巴韦林的基础上,加用芪参二莲汤治疗慢性丙型病毒性肝炎（CHC）的临床疗效。方法：选取我院2011年5月-2012年1月HCV RNA阳性的1b型CHC患者62例随机分为两组,治疗组30例,采用PEG IFNα-2a联合利巴韦林加芪参二莲汤治疗,对照组32例应用PEG IFNα-2a联合利巴韦林治疗,疗程48周,疗程结束后随访24周。并观察治疗前、后两组患者肝功能、HCV RNA及PBMC变化。结果：治疗组EVR为76.67%,ETVR为86.67%,随访SVR为83.33%;对照组分别为34.37%、50.00%、31.32%。两组病毒学应答比较,治疗组EVR、ETVR、SVR较对照组疗效显著,其差异均具有统计学意义（P〈0.05）。两组患者治疗48周后,ALT、TBil与本组治疗前比较,差异均具有统计学意义（P〈0.05）,其中治疗组ALT与同组治疗前比较,差异具有显著意义（P〈0.01）;两组患者治疗48周后,两组间同时段ALT及TBil比较,治疗组更优于对照组,差异均具有统计学意义（P〈0.05）。两组患者治疗48周后IL-10水平较本组治疗前均有所降低,差异均有统计学意义（P〈0.05）;两组间治疗后48周同时段相比较,治疗组患者改善优于对照组,差异有统计学意义（P〈0.05）,随访24周,两组间比较,差异仍具有统计学意义（P〈0.05）。治疗48后两组患者IL-12水平较本组治疗前比较差异均无统计学意义（P〉0.05）,但随访24周显示,治疗组IL-12水平较同时段对照组比较,差异有统计学意义（P〈0.05）。结论：芪参二莲汤加PEG IFNα-2a联合利巴韦林治疗1b型CHC疗效显著,明显优于单用干扰素联合利巴韦林的临床疗效。不仅可以显著抑制HCV RNA复制,改善肝功能,而且可以减轻不良反应,预后良好稳定,值得临床推广。     

聚乙二醇干扰素α-2a联合利巴韦林治疗慢性丙型肝炎患者的病毒学应答

目的观察聚乙二醇干扰素α-2a（PEG-IFNα-2a）联合利巴韦林治疗慢性丙型肝炎（CHC）的疗效。方法回顾性分析在本院门诊接受抗病毒治疗的58例CHC患者,其中HCV-1型患者43例,HCV-2型患者15例,均给予PEG-IFNα-2a和利巴韦林治疗,疗程48周。分别在治疗前、治疗后4、12、24周,治疗终点,治疗结束后24周及48周测定患者血浆HCV RNA水平。结果 HCV-2型患者4周快速病毒学应答（RVR）率明显高于HCV-1型患者（80%vs 48.8%,P〈0.05）;治疗结束后随访48周HCV-2型患者的持续病毒应答（SVR）率明显高于1型患者（86.7%vs 53.5%,P〈0.05）。低病毒载量患者（RNA〈2×106拷贝/ml）的RVR率明显高于高病毒载量患者（93.8%vs 46.2%,P〈0.05）;治疗结束后随访48周低病毒载量患者的SVR率明显高于高病毒载量者（84.2%vs 51.3%,P〈0.05）。结论 PEG-IFNα-2a联合利巴韦林治疗CHC安全有效,对基因2型疗效优于基因1型,病毒载量低的患者疗效优于病毒载量高的患者。     

长效与短效α-干扰素治疗慢性丙型肝炎疗效观察

目的：对比长效干扰素联合利巴韦林与普通干扰素联合利巴韦林治疗慢性丙型肝炎的临床疗效及安全性。方法回顾性分析60例慢性丙型肝炎患者的临床资料,其中长效干扰素组采用聚乙二醇干扰素α-2a （PEG-INFα-2a）联合利巴韦林进行抗病毒治疗（n=30例）,普通干扰素组采用普通IFNα-2a联合利巴韦林治疗（n=30例）,均分别于治疗4、12、24、48w及治疗结束后24w评价疗效,并观察药物的不良反应。结果长效干扰素组持续病毒学应答率（SVR）为90.0%,显著高于普通干扰素组的56.7%（P〈0.01）;两组药物不良反应均有发热、肌肉酸痛、脱发及中性粒细胞、血小板下降等,但长效干扰素组发生发热和肌肉酸痛比率分别为36.7%和33.3%,显著低于普通干扰素组（90.0%和93.3%,P〈0.01）;长效干扰素组中性粒细胞下降明显高于普通干扰素组,在4～24w尤其明显。结论长效干扰素联合利巴韦林治疗方案疗效显著优于普通干扰素联合利巴韦林,且未增加不良反应。     

聚乙二醇干扰素加利巴韦林治疗慢性丙型肝炎疗效影响因素分析

目的研究聚乙二醇干扰素α-2a联合利巴韦林治疗慢性丙型肝炎（丙肝）疗效的影响因素。方法101例慢性丙肝患者均给予聚乙二醇干扰素α-2a 180μg／周联合利巴韦林10．6～15．0mg／（kg·d）,疗程48周,分析性别、体重指数（body mass index,BMI）、初始HCVRNA定量、ALT及GLU等对持续病毒学应答（sustainedvirologicresponse,SVR）的影响。结果聚乙二醇干扰素α-2a联合利巴韦林治疗慢性丙肝总的SVR率为50％,其中获得快速病毒学应答（rapid virologic response．RVR）和早期病毒学应答（early virologic response,EVR）患者实现SVR达100％,未获得RVR和EVR患者实现SVR为19．35％;高BMI值、发生脂肪肝的患者不容易达到SVR,而糖化血红蛋白、初始HCVRNA载量高、GLU、ALT及性别对SVR无影响。结论RVR、EVR可以预测SVR;BMI、是否合并脂肪肝是聚乙二醇干扰素α-2a联合利巴韦林治疗慢性丙肝获得SVR的影响因素。     

Comparison of a 6-month course peginterferon alpha-2b plus ribavirin and interferon alpha-2b plus ribavirin in treating Chinese patients with chronic hepatitis C in Taiwan

Previous studies in Caucasian patients showed treatment of chronic hepatitis C with pegylated interferon/ribavirin was well tolerated, and produced a higher response rate especially in genotype 1 infections. However, it is unknown whether this conclusion can be extrapolated to patients with Chinese ethnic origin. A total of 153 patients with biopsy-proven chronic hepatitis C were randomly assigned to receive either weekly injection of peginterferon alpha-2b 1.5 mcg/kg plus oral ribavirin (1000 or 1200 mg/day, depending on body weight) (PEG group, n = 76) or 3 MU of interferon alpha-2b t.i.w. plus ribavirin (IFN group, n = 77) for 24 weeks. Sustained virological response (SVR) was defined as the sustained disappearance of serum hepatitis C virus (HCV) RNA at 24 weeks after the end of treatment by polymerase chain reaction assay. Baseline demographic, viral and histological characteristics were comparable between the two groups. Using an intent-to-treat analysis, HCV genotype 1 patients showed a significantly higher SVR in patients receiving PEG-IFN rather than IFN (65.8%vs 41.0%, P = 0.019), but no difference was found in genotype non-1 patients (PEG vs IFN: 68.4%vs 86.8%, P = 0.060). Genotype 1 patients (28.6%) in the PEG-IFN group relapsed, as compared with 52.9% in the IFN group (P = 0.040). Multivariate analyses showed early virological response at week 12 of therapy and genotype non-1 were significant predictors to SVR. As compared with the IFN group, patients receiving PEG-IFN had a significantly higher rate of discontinuation, dose reduction, fever, headache, insomnia, leucopenia and thrombocytopenia. In genotype 1 chronic hepatitis C Chinese patient, PEG-IFNalpha2b ribavirin had significantly better SVR and lower relapse rate when compared to IFN/ribavirin. Both regimens can be recommended for genotype non-1 chronic hepatitis C Chinese patients. However, a higher rate of adverse events and discontinuance of therapy were noted in patients treated with PEG-IFNalpha2b ribavirin.     

Efficacy of interferon alpha-2b induction therapy before retreatment for chronic hepatitis C.

BACKGROUND/AIMS: Chronic hepatitis C (HCV) patients who have failed previous treatment have low sustained viral response (SVR) rates with repeat treatment. We evaluated whether interferon (IFN) induction during retreatment improves response rates. METHODS: Two randomized, controlled trials were conducted in chronic HCV patients who failed IFN. In Study 1, patients received IFN 3 MU daily plus ribavirin (RBV) 1000 mg/day for 4 weeks, followed by IFN 3 MU TIW plus RBV 1000 mg/day for 44 weeks (induction; n=232), or IFN 3 MU TIW plus RBV 1000 mg/day for 48 weeks (non-induction; n=237). In Study 2, patients received IFN 5 MU B.I.D. plus RBV 1000-1200 mg/day for 2 weeks, followed by pegylated IFN (PEG-IFN) 75-150 mug weekly plus RBV 1000-1200 mg/day for 46 weeks (induction; n=201), or PEG-IFN 75-150 mug weekly plus RBV 1000-1200 mg/day for 48 weeks (non-induction; n=206). The primary end point for both trials was SVR. RESULTS: Induction did not increase SVR compared with non-induction, but did increase the on-treatment response among genotype non-1 patients in Study 2. By intention-to-treat (ITT) analysis, SVR in Study 1 was 13% for induction vs. 9% for non-induction (P=NS). In Study 2 (ITT), SVR was 20% for induction vs. 24% for non-induction (P=NS). However, by non-ITT analysis of Study 2, genotype non-1-previous non-responders showed significantly higher response rates with induction than non-induction. CONCLUSION: For chronic HCV patients who have failed IFN, induction with retreatment does not improve SVR, but may be beneficial for patients with genotype non-1 HCV.     

Peginterferon alfa-2b plus ribavirin for naïve patients with genotype 1 chronic hepatitis C: a randomized controlled trial

BACKGROUND/AIMS: We assessed the effectiveness and safety of an induction dose of peginterferon alfa-2b (PEG-IFN) plus ribavirin for initial treatment of patients with genotype 1 chronic HCV infection in a randomized, controlled, multicenter trial. METHODS: Three hundred and eleven na?ve patients infected with genotype 1 and chronic hepatitis were randomly assigned to 48-week treatment with PEG-IFN once weekly (80-100 micrograms depending on body weight for 8 weeks, followed by 50 micrograms for the next 40 weeks), or standard interferon alfa-2b (IFN) 6 million units on alternate days, both in combination with ribavirin (1000-1200 mg/day). RESULTS: PEG-IFN plus ribavirin significantly increased sustained virological response (SVR) compared with IFN plus ribavirin (41.1 vs. 29.3% respectively, P=0.030). Less patients discontinued PEG-IFN than IFN (19 vs. 31%, P=0.010). By logistic regression, SVR in the PEG-IFN group was independently associated with age <50 years, and mild fibrosis at liver biopsy. CONCLUSIONS: Combination therapy with an induction dose of PEG-IFN was a more effective and better tolerated treatment for na?ve patients with genotype 1 than combination therapy with high dose standard IFN. In patients aged less than 50 years with mild fibrosis this schedule achieves a very high rate of SVR.     

血脂水平与慢性丙型肝炎患者抗病毒疗效的相关性分析

目的分析慢性丙型肝炎(CHC)患者血脂水平与抗病毒疗效的相关性,为评估预后、指导治疗提供依据。方法纳入2010年1月至2013年8月收治的171例CHC初治患者,给予聚乙二醇干扰素(PEG-IFN)及利巴韦林抗病毒治疗,分析比较不同应答情况、基因型及治疗0、12及24周(非1b型)或0、24及48周(1b型)患者血清总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)、载脂蛋白A(apoA)、载脂蛋白B(apoB)水平。正态分布计量资料采用t检验及方差分析;非正态分布资料采用秩和检验;分类变量采用χ2检验。采用单因素及多因素Logistic回归分析筛选与患者预后相关的预测因子。结果171例CHC PEG-IFN及利巴韦林抗病毒初治患者治疗后,获得持续病毒学应答(SVR)率及未获得持续病毒学应答(nonSVR)率分别为81.87%、18.13%,SVR组患者TG、apoB明显较non-SVR组患者低(P0.05)。基因3型CHC患者TC、LDL-C、apoA及apoB均较基因1b、6a型患者低;ALT、AST水平相比较高(P0.05)。SVR组患者TG、apoB在治疗结束时升高,HDL-C降低(P0.05);non-SVR组患者血脂水平在治疗过程中无明显改变。单因素Logistic分析示患者年龄≤50岁、基因型非1b型、TG≤3.11 mmol/L、apoB≤0.63 g/L与SVR密切相关(P0.05);多因素回归分析表明,年龄≤50岁及apoB≤0.63 g/L CHC患者易获得SVR(P0.05)。结论本研究提示,血脂水平和年龄与CHC患者抗病毒疗效密切相关,年龄≤50岁和apoB≤0.63 g/L是CHC患者SVR的独立预测因素。     

不同聚乙二醇化干扰素治疗丙型肝炎病毒感染临床观察

目的评价聚乙二醇化干扰素α-2a或α-2b(PEG-IFNα-2a/α-2b)联合利巴韦林治疗慢性丙型肝炎病毒感染的疗效与副作用,以优化慢性丙型肝炎治疗策略、提高临床治愈率。方法 60例慢性丙型肝炎患者随机分为A组和B组各30例,分别给予PEG-IFNα-2a加利巴韦林(A组)和PEG-IFNα-2b加利巴韦林(B组)治疗48周,检测基线及治疗4周、l2周、48周及治疗结束后24周时的血清HCV-RNA水平,比较两组快速病毒学应答(RVR)率、早期病毒学应答(EVR)率、治疗终点病毒学应答(ETVR)率、持续病毒学应答(SVR)以及复发率与不良反应。结果 A组和B组RVR、EVR、ETVR、SVR、复发率分别为46.7%、63.3%、86.7%、80.0%、6.7%和40.0%、56.7%、80.0%、76.7%、3.3%,组间比较,差异均无统计学意义(P0.05),两组的安全性情况相似,未见严重的不良事件,总体耐受性好。结论两种现有的聚乙二醇化干扰素α-2a或α-2b联合利巴韦林治疗丙型肝炎病毒感染的持续病毒学应答率和耐受性没有显著差异。     

Sustained virological response in a predominantly hepatitis C virus genotype 4 infected population

AIM： To assess sustained virological response （SVR） rates in a predominantly hepatitis C virus （HCV） genotype 4 infected population. METHODS： Between 2003-2007, 240 patients who were treated for chronic hepatitis C infection at our center were included. Epidemiological data, viral genotypes, and treatment outcomes were evaluated in all treated patients. Patients with chronic renal failure, previous non-responders, and those who relapsed after previous treatment were excluded from the study. Among all patients, 57% were treated with PEG- interferon （IFN） α-2a and 43% patients were treated with PEG-IFN α-2b; both groups received a standard dose of ribavirin. RESULTS： 89.6% of patients completed the treatment with an overall SVR rate of 58%. The SVR rate was 54% in genotype 1, 44% in genotype 2, 73% in genotype 3, and 59% in genotype 4 patients. There was no statistical difference in the SVR rate between patients treated with PEG-IFN α-2a and PEG-IFN α-2b （61.5% vs 53%）. Patients younger than 40 years had higher SVR rates than older patients （75% vs 51%, P = 0.001）. SVR was also statistically significantly higher when the HCV RNA load （pretreatment） was below 800.000 （64% vs 50%, P = 0.023）, in patients with a body mass index （BMI） less than 28 （65% vs 49%, P = 0.01）, and in patients who completed the treatment duration （64% vs 8%, P ≤ 0.00001）.CONCLUSION： The SVR rate in our study is higher than in previous studies. Compliance with the standard duration of treatment, higher ribavirin dose, younger age, lower BMI, and low pretreatment RNA levels were associated with a higher virological response.