Myers R P, Patel K, Pianko S, Poynard T, McHutchison J G
Division of Gastroenterology, Hôpital La Pitié-Salpêtrière, Paris, France.
J Viral Hepat. 2003 Jan;10(1):16-22. doi: 10.1046/j.1365-2893.2003.00387.x.
The response to antiviral therapy and the rate of fibrosis progression in chronic hepatitis C virus (HCV) infection are related to common factors, including age and gender. The aim of this study was to evaluate the relationship between the rate of fibrosis progression and the sustained virologic response (SVR) to interferon (IFN)-based treatment. A total of 332 patients treated for chronic HCV infection were evaluated. Using multivariate logistic regression analysis, the impact of the rate of fibrosis progression (defined as the stage of liver fibrosis according to the Metavir system/duration of infection) on the rate of SVR (negative HCV RNA at least 6 months following the end of treatment), was determined. The median age of the patients was 44 (range 25-77) years, 64% were male, and 66% were infected with genotypes 1, 4, 5 or 6. The median rate of fibrosis progression was 0.083 (range 0-2) Metavir units/year; 158 patients (48%) had F2-F4 fibrosis. After a median of 48 (range 2-126) weeks of therapy (IFN, n=190; IFN and ribavirin, n=96; pegylated IFN, n=20; pegylated IFN and ribavirin, n=26), 93 patients (28%) achieved an SVR. In univariate analysis, the rate of SVR was higher in slow [< 0.083 Metavir units/year (n=162)] than rapid progressors [> or = 0.083 Metavir units/year (n=170)] (35%vs 22%, P=0.01). After controlling for age, gender, genotype, viral load, and treatment regimen and duration, the rate of fibrosis progression remained an independent predictor of SVR (slow vs rapid progressors, OR 2.74; 95% CI 1.27-5.92; P=0.01). Hence the rate of fibrosis progression is an independent predictor of SVR to IFN-based therapy in patients with chronic hepatitis C. This additional factor should be considered in economic models evaluating this condition.
慢性丙型肝炎病毒（HCV）感染对抗病毒治疗的反应以及纤维化进展速率与包括年龄和性别在内的常见因素有关。本研究的目的是评估纤维化进展速率与基于干扰素（IFN）治疗的持续病毒学应答（SVR）之间的关系。共评估了332例接受慢性HCV感染治疗的患者。使用多因素逻辑回归分析，确定纤维化进展速率（根据梅塔维（Metavir）系统定义的肝纤维化阶段/感染持续时间）对SVR率（治疗结束后至少6个月HCV RNA呈阴性）的影响。患者的中位年龄为44岁（范围25 - 77岁），64%为男性，66%感染1、4、5或6型基因型。纤维化进展的中位速率为0.083（范围0 - 2）梅塔维单位/年；158例患者（48%）有F2 - F4级纤维化。经过中位48周（范围2 - 126周）的治疗（IFN，n = 190；IFN和利巴韦林，n = 96；聚乙二醇化IFN，n = 20；聚乙二醇化IFN和利巴韦林，n = 26），93例患者（28%）实现了SVR。在单因素分析中，进展缓慢者[< 0.083梅塔维单位/年（n = 162）]的SVR率高于进展快速者[≥ 0.083梅塔维单位/年（n =
170）]（35%对22%，P = 0.01）。在控制年龄、性别、基因型、病毒载量以及治疗方案和疗程后，纤维化进展速率仍然是SVR的独立预测因素（进展缓慢者与进展快速者相比，OR 2.74；95%CI 1.27 - 5.92；P = 0.01）。因此，纤维化进展速率是慢性丙型肝炎患者基于IFN治疗的SVR的独立预测因素。在评估这种疾病的经济模型中应考虑这一额外因素。
