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

doi:10.3969/j.issn.1672-5069.2014.02.010

实用肝脏病杂志 ›› 2014, Vol. 17 ›› Issue (2): 149-153.doi: 10.3969/j.issn.1672-5069.2014.02.010

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

李剑萍，关玉娟，洪文昕，范浰婴，潘能浪，杨可立

510060广州市第八人民医院肝二科（李剑萍，关玉娟，范浰婴，潘能浪，杨可立）；感染病科（洪文昕）

收稿日期:2013-11-22 出版日期:2014-08-20 发布日期:2016-04-15
通讯作者: 关玉娟 E-mail:guanyj9992@163.com
作者简介:李剑萍，女，38岁，大学本科，副主任医师。主要从事病毒性肝炎诊断与治疗学研究。E-mail:ljp1975@aliyun.com
基金资助:
广州市医药卫生科技项目(编号:201102A213186);广东省科技计划项目（编号：20110316）；广东省药学会项目（编号：2012GRS02）

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

Li Jianping，Guan Yujuan，Hong Wenxin，et al.

Eighth People’s Hospital，Guangzhou 510060，Guangdong Province，China

Received:2013-11-22 Online:2014-08-20 Published:2016-04-15

摘要/Abstract

摘要： 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（180 μg/w或135 μg/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。

关键词: 慢性丙型肝炎, 聚乙二醇干扰素α-2a, 利巴韦林, 病毒学应答

Abstract: 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，respectively. Results Rapid virologic response（RVR），early virologic response （EVR） and sustained virologic response （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.

Key words: Chronic hepatitis C, Interferon alpha-2a, Ribavirin, Virologic response

李剑萍，关玉娟，洪文昕，范浰婴，潘能浪，杨可立. 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[J]. 实用肝脏病杂志, 2014, 17(2): 149-153.

Li Jianping，Guan Yujuan，Hong Wenxin，et al.. Efficacy and influence factors of pegylated interferon alpha-2a plus ribavirin for treatment of patients with chronic hepatitis C[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2014, 17(2): 149-153.

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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

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

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