聚乙二醇干扰素α-2a联合利巴韦林治疗ALT正常的慢性丙型肝炎疗效观察

摘要/Abstract

摘要： 目的评价聚乙二醇（PEG）干扰素联合利巴韦林治疗ALT正常的慢性丙型肝炎的临床疗效。方法使用聚乙二醇干扰素α-2a联合利巴韦林治疗20例ALT正常和25例ALT升高的慢性丙型肝炎患者。分别于治疗12周、48周及治疗结束后24周评价疗效,并观察药物副反应。结果 ALT正常组所有患者均完成治疗,在治疗12周时的早期应答率为45%（9/20）,治疗结束时的应答率为55%（11/20）,在治疗结束后随访24周,持续应答率为45%（9/20）。2例患者在随访24周内出现ALT升高,血清HCV RNA阳转,复发率为18.2%（2/11）,所有疗效指标与ALT升高组对比均无显著差异。结论 PEG干扰素联合利巴韦林治疗ALT正常的慢性丙型肝炎同样具有较好的临床疗效, 且副反应较轻。

关键词: 慢性丙型肝炎, 聚乙二醇干扰素, 利巴韦林, 谷丙转氨酶

Abstract: Objective To evaluate the clinical effects of peginterferon and ribavirin treatment on chronic hepatitis C patients with normal serum alanine aminotransferase（ALT）. Methods 20 chronic hepatitis C patients with normal ALT and 25 patients with increased ALT were treated with peginterferon（ Pegasys） and ribavirin. Curative effect were evaluated at the 12,24 and 48 weeks during the treatment. The adverse effects of the treatment were evaluated at the same time. Result All patients with normal ALT completed the whole course of treatment. Following up studies were conducted at the 24th week after the treatment. The SVR was 45%（9/20）. At the 12th week during the treatment,the EVR was 45%（9/20）. At the end of treatment,the ETVR was 55%（11/20）. Two patients had an increase in ALT and HCV RNA level after the 24 weeks of treatment. The recurrence rate was 18.2%（2/11）. All the indexes had no statistically significant difference between the normal ALT and increased ALT group. Conclusion Combination of peginterferon and ribavirin may be used for the treatment of chronic hepatitis C patients with normal serum alanine aminotransferase. The side effect of treatment is slight.

Key words: Chronic hepatitis C, Peginterferon, Ribavirin, Alanine aminotransferase

何纲. 聚乙二醇干扰素α-2a联合利巴韦林治疗ALT正常的慢性丙型肝炎疗效观察[J]. 实用肝脏病杂志, 2010, 13(1): 39-41.

HE Gang.. Treatment for chronic hepatitis C patients with normal serum alanine aminotransferase by peg-IFN alpha-2a and ribavirin[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2010, 13(1): 39-41.

参考文献

[1] 中华医学会肝病学分会、中华医学会传染病与寄生虫病学分会. 丙型肝炎防治指南[J]. 实用肝脏病杂志,2004,7（3）：附1-附6.
[2] MANORI S,SUZUKI F,HOSAKA T,et al. Interferon monotherapy for patients with chronic hepatitis C and normal serum aminotransferase levels at commencement of treatment[J]. Gastroenterology,2004,39（8）：776-782.
[3] BECON BR. Treatment of patients with hepatitis C and normal serum aminotransferase level[J]. Hepatology,2002,36（5 Suppl）：S179-S184.
[4] OKANOU E,MAKIYAM AA,NAKAYAMA M,et al. A follow-up study to determine the value of liver biospy and need for anti-viral therapy for hepatitis C carriers with persistently normal serum aminotransferase[J]. J Hepatol,2005,43：599-605.
[5] JACOBSON IM,AHMED F,RUSSO MW,et al. Interferon alfa-2b and ribavirin for patients with chronic hepatitis C and normal ALT[J]. Am J Gastroenterol,2004,99：1700-1705.
[6] ROBERT J,POKORSKI. Hepatitis C virus infection in Japan[J]. Risk Insights,2001,2：33-38.
[7] PUOTI C,CASTELLACCI R,MONTAGNESE F,et al. Histologic and virological features and follow-up of hepatitis C virus carriers with normal serum aminotransferase level：the Italian prospective study of the asymptomatic C carriers（ISACC）[J]. J Hepatol,2002,37：117-123
[8] WAGNER MV,LEE JH,FRIEDL R,et al. Impaired quality of life in patients with chronic hepatitis C and persistently normal serum aminotransferase levels[J]. Hepatology,2003, 38：454A.
[9] LEE SS,SHERMAN M. Pilot study of interferon-alpha and ribavirin treatment in patients with chronic hepatitis C and normal transaminase values[J]. J Viral Hepat,2001,8：202-205.
[10] ERHARDT A,BEHLEN-WILM U,ADAM S,et al. Combination treatment of IFNalpha2b and ribavirin in patients with chronic hepatitis C and persistently normal ALT[J]. Dig DIS Sci,2003,48：921-925.
[11] ZEUZEM S,DIAGO M,GANE E,et al. Peginterferon alfa-2a（40 kilodaltons） and ribavirin in patients with chronic hepatitis C and normal aminotransferase levels[J]. Gastroenterology,2004,127：1724-1732.

[1]	张迎明, 申爽, 田飞, 孙园园. IFNL4和IL-28B基因多态性检测评估慢性乙型肝炎患者抗病毒治疗应答价值分析^*[J]. 实用肝脏病杂志, 2019, 22(6): 828-831.
[2]	潘美民, 李文娟, 蒋芳清, 杨丽晖, 谭永卫, 何娟, 阮建文, 蔡春琳. 慢性丙型肝炎患者血清IL-17A、FGF和IL-7水平与丙型肝炎病毒感染自发清除临床意义探讨^*[J]. 实用肝脏病杂志, 2019, 22(6): 840-843.
[3]	涂杰霞, 王安娜, 廖若汐. 干扰素α-2b与聚乙二醇干扰素α-2a治疗慢性乙型肝炎患者疗效比较研究*[J]. 实用肝脏病杂志, 2019, 22(5): 648-651.
[4]	邓浩辉, 李晓强, 高洪波, 陈伟烈. HIV/HCV混合感染者与HCV感染者感染HCV基因型分析*[J]. 实用肝脏病杂志, 2019, 22(5): 656-659.
[5]	袁春晖, 李春雨, 李红丽, 赵红娜, 王文红, 孟庆旭, 张中学. 国产聚乙二醇化干扰素α治疗HBeAg阳性慢性乙型肝炎患者疗效研究[J]. 实用肝脏病杂志, 2019, 22(3): 353-356.
[6]	刘立, 李俊义, 杜映荣, 刘春云, 李卫昆, 王辉, 李惠敏, 常丽仙, 祁燕伟. 索磷布韦/达拉他韦治疗慢性丙型肝炎患者疗效及安全性分析：一项真实世界研究[J]. 实用肝脏病杂志, 2019, 22(3): 361-364.
[7]	袁春晖,李春雨,李红丽,赵红娜,王文红,孟庆旭,张中学. IL28B基因多态性对聚乙二醇干扰素α治疗HBeAg阳性慢性乙型肝炎患者疗效的影响[J]. 实用肝脏病杂志, 2019, 22(2): 184-187.
[8]	蒋奕,刘冰. 慢性乙型肝炎与慢性丙型肝炎患者临床和肝组织病理学特征分析[J]. 实用肝脏病杂志, 2019, 22(2): 188-191.
[9]	吴静,东保吉,吴超. 慢性丙型肝炎患者外周血滤泡辅助性T淋巴细胞表面PD-1受体表达及意义研究^*[J]. 实用肝脏病杂志, 2019, 22(2): 192-195.
[10]	吴亚平,周冰清,蒋蓓莉. 慢性丙型肝炎患者发生重度肝纤维化相关因素分析^*[J]. 实用肝脏病杂志, 2019, 22(2): 196-199.
[11]	杨珍杰,李洪涛,王剑,李霞,陈媛. 聚乙二醇化干扰素α-2a联合利巴韦林治疗代偿期丙型肝炎肝硬化患者临床疗效研究^*[J]. 实用肝脏病杂志, 2019, 22(2): 232-235.
[12]	侯春阳, 马玉梅, 李方治. Peg-IFNα-2b联合利巴韦林治疗基因1/6型慢性丙型肝炎患者临床研究^*[J]. 实用肝脏病杂志, 2019, 22(1): 53-56.
[13]	赵鹏, 王磊. 聚乙二醇化干扰素-α对不同基因型慢性丙型肝炎患者治疗效果比较^*[J]. 实用肝脏病杂志, 2019, 22(1): 57-60.
[14]	曹艳平, 隋洪婷, 潘猛, 曲宝聚, 朴红心. 恩替卡韦联合聚乙二醇干扰素或胸腺素治疗代偿期乙型肝炎肝硬化2年疗效随访^*[J]. 实用肝脏病杂志, 2019, 22(1): 93-96.
[15]	周思思, 沈有秀, 李娟, 俞科贤. 慢性丙型肝炎和肝硬化患者外周血Th17和Treg细胞及其相关细胞因子水平变化^*[J]. 实用肝脏病杂志, 2018, 21(5): 689-692.