慢性丙型肝炎干扰素治疗后复发患者干扰素联合利巴韦林再治疗

目的 探讨干扰素（IFN）治疗后复发的慢性丙型肝炎（CHC）患者对IFN联合利巴韦林再治疗的应答情况及影响因素。方法 100例IFN治疗后复发的CHC患者中，50例使用聚乙二醇干扰素α-2a（PEG—IFNα-2a），50例使用重组人干扰素α-1b（CIFNα—1b），均联合利巴韦林再治疗，联合治疗48周，停药随访24周，分析HCVRNA载量、病毒基因型、药物种类对联合治疗疗效的影响。结果 100例复发患者联合再治疗后，36．00％取得持续病毒学应答（SVR），其中PEG-IFNα-2a组48．00％取得SVR，显著高于CIFNα—1b组（24．00％，P〈0．05）。56例低病毒载量（HCV-RNA〈1×10^5拷贝／mL）患者中，PEG—IFNα-2a组28例，其中57．14％取得SVR，显著高于CIFNα—1b组（25．00％，P〈0．05）。HCV非基因1（2a或2b）型组29例，其中55．17％取得SVR，显著高于基因1型组（28．20％，P〈0．05）；在CIFNα—1b治疗组，病毒非基因1型17例患者，其中47．06％取得SVR，明显高于基因1型患者（12，12％，P〈0．01）；在基因1型组，PEG—IFNα-2a组38例，其中42．11％取得SVR，显著高于CIFNα—1b组（12．12％，P〈0.01）。结论 IFN治疗后复发的CHC患者IFN联合利巴韦林再治疗存在部分患者无应答；对于HCV病毒载量低、基因1型的复发患者，聚乙二醇干扰素联合利巴韦林再治疗疗效明显优于普通干扰素的联合治疗。

Retreatment with interferon plus ribavirin in patients with relapsed chronic hepatitis C

Objective To evaluate the efficacy and to investigate the influencing factors of the interferon（IFN） plus ribavirin retreatment for patients with chronic hepatitis C（CHC） relapsed after a previous IFN treatment. Methods A retrospective study was designed to analyze the retreatment with IFN of 100 relapsed CHC patients. There were 50 patients treated with PEG-IFNα-2a plus ribavirin and 50 patients treated with CIFNα-1 b plus ribavirin. The main parameter to evaluate the efficacy was sustained viral response （SVR） rate. The influences of HCV RNA load in serum, genotype and drug categories on the responses to IFN were analyzed. Results For all the patients, the SVR rate was 36.00%. The SVR rate of PEG-IFNα-2a was markedly higher than that of CIFNα-1b （48.00% and 24.00% , P 〈 0.05 ）. Among the 56 patients with low viral loads（ 〈 1 × 10^5 copies/mL） , the SVR rate of PEG-IFNα-2a was markedly higher than that of CIFNα-1b （57. 14% and 25.00% , P 〈0. 05）. The SVR rate of the patients with genotype non-1 was markedly higher than that of the patients with genotype non-1 （55.17% and 28.20% , P 〈0.05） ; In the CIFNα- 1 b group, The SVR rate of the patients with genotype non-1 was significantly higher than that of the patients with geno- type 1 （47.06% and 12. 12% , P 〈0.01 ） ; Among patients with genotype 1, the SVR rate of PEG-IFNα-2a was signifi- cantly higher than that of CIFNα-1b （42. 11% and 12. 12% , P 〈 0.01 ）. Conclusion Some relapsed C HC patients are not response to the IFN plus ribavirin retreatment. The relapsed patients with low viral loads or with genotype 1 are response well to PEG-IFNα-2a plus ribavirin than to CIFNα-1b plus ribavirin.