不同抗病毒治疗方案治疗慢性丙型肝炎患者疗效分析

doi:10.3969/j.issn.1672-5069.2015.05.012

摘要/Abstract

摘要： 目的观察慢性丙型肝炎患者个体化抗病毒治疗方案的疗效。方法选取我院2008年1月至2013年1月收治的179例慢性丙型肝炎患者，根据患者年龄、体质量、血清HCV载量和HCV基因型的不同，选择不同类型和不同剂量的干扰素联合利巴韦林治疗方案。在179例患者中，65例患者接受聚乙二醇干扰素α-2a（PegIFN α）治疗，114例接受普通干扰素（IFN α-1b）治疗。治疗48 w，随访24 w。比较两组在不同干扰素剂量、病毒载量和不同病毒基因型患者病毒学应答率的差异。结果在随访时，65例接受PegIFN α治疗的慢性丙型肝炎患者快速病毒学应答率（RVR）、早期病毒学应答率（EVR）和持续病毒学应答率（SVR）分别为47.7%、92.3%、93.8%，与普通干扰素1b组的58.8%、76.3%、80.7%比较，差异有统计学意义（P<0.05）； 43例接受常规剂量PegIFN α-2a治疗的患者RVR、EVR和SVR分别为46.5%、97.7%和100.0%，与22例接受小剂量组的50.0%、81.8%和81.8%比，无显著性统计学差异（P>0.05）；69例接受常规剂量普通干扰素治疗的患者RVR、EVR和SVR分别为60.9%、76.8%和82.6%，与45例接受小剂量组的55.6%、75.6%和77.8%比，无显著性统计学差异（P>0.05）；14例接受PegIFN α-2a治疗的血清病毒低载量患者RVR、EVR和SVR分别为64.3%、85.7%和85.7%，与51例高病毒载量组的43.1%、94.1%和96.1%比，无显著性统计学差异（P>0.05）；24例接受普通干扰素治疗的血清低病毒载量患者的RVR、EVR和SVR分别为54.2%、66.7%和70.8%，与90例高病毒载量组的60.0%、78.9%和81.1%比，无显著性统计学差异（P>0.05）；41例接受PegIFN α-2a治疗的基因1型患者的RVR、EVR和SVR分别为31.7%、97.6%和97.6%，与24例非基因1型患者的75.0%、87.5%和87.5%存在显著性统计学差异（P<0.05）；81例接受普通干扰素治疗的基因1型患者的RVR、EVR和SVR分别为46.9%、82.7%和87.6%，与33例非基因1型的66.7%（P<0.05）、75.7%（P>0.05）和78.8%（P>0.05）也存在差异。结论根据CHC患者的基线特征、耐受性、HCV基因型及病毒学应答出现的时间优化抗病毒治疗方案，有利于个体化治疗，以获得较高的病毒学应答率，改善预后。

关键词: 慢性丙型肝炎, 聚乙二醇干扰素α-2a, 利巴韦林, 病毒载量, 基因型

Abstract: Objective To observe the efficacy of individualized treatment strategy in patients with chronic hepatitis C. Methods A total of 179 patients with chronic hepatitis C were recruited in this study. 65 received pegylated interferon α-2a （PegIFN α） and ribavirin，and 114 received IFN α-1b. All patients were treated for 48 weeks and followed-up for 24 weeks. According to the patient's age，body weight，serum HCV load and HCV genotype，the dose of interferon was modulated. Results At the end of follow-up，rates of rapid virologic response （RVR），early virologic response（EVR） and sustained virologic response in 65 patients receiving pegIFN α were 47.7%，92.3%，93.8%，much higher than those in IFN α-1b-treated patients （58.8%，76.3%，80.7%， respectively，P<0.05）；the RVR，EVR and SVR in 43 patients receiving normal doses of pegIFN α-2 were 46.5%，97.7% and 100.0%，without significant difference as compared to 50.0%，81.8% and 81.8% in 22 patients with decreased dose of pegIFN α-2（P>0.05）；the RVR，EVR and SVR in 69 patients receiving normal dose of IFN α1b were 60.9%，76.8% and 82.6%，without significant difference compared to 55.6%，75.6% and 77.8% in 45 patients receiving decreased dose of IFN α1b（P>0.05）；the RVR，EVR and SVR in 14 patients with low viral load receiving pegIFN α-2a were 64.3%，85.7% and 85.7%，without significant difference compared to 43.1%，94.1% and 96.1% in 51 patients with high viral load（P>0.05）；the RVR，EVR and SVR in 24 patients with low viral load receiving IFN α1b were 54.2%，66.7% and 70.8%，without significant difference compared to 60.0%，78.9% and 81.1% in 90 patients with high viral load（P>0.05）；the RVR，EVR and SVR in 41 patients with hepatitis C viral genotype 1 infection receiving pegIFN α-2a were 31.7%，97.6% and 97.6%，significantly different with 75.0%，87.5% and 87.5% in 24 patients with non-genotype 1 infection（P<0.05）；the RVR，EVR and SVR in 81 patients with genotype 1 infection receiving IFN α1b were 46.9%，82.7% and 87.6%，significantly different with 66.7%（P<0.05），75.7%（P>0.05） and 78.8% （P>0.05） in 33 with non-genotype 1 infection. Conclusion According to baseline characteristics，tolerability and HCV genotype，the standardized antiviral regimen should be optimized， which might get a higher virologic response and improve the prognosis of patients with chronic hepatitis C.

Key words: Hepatitis C, Pegylated interferon α-2a, Ribavirin, Viral load, Genotype

关翠英，阿娜尔古丽?穆哈买尔，王亚楠，葛力菲，郭宇. 不同抗病毒治疗方案治疗慢性丙型肝炎患者疗效分析[J]. 实用肝脏病杂志, 2015, 18(5): 496-499.

Guan Cuiying, Anaerguli Muhamaier，Wang Yanan，et al.. Antiviral strategies of standardized regimen in patients with chronic hepatitis C[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2015, 18(5): 496-499.

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