Liu Louis W C, Tomlinson George, Mazzulli Tony, Murray Alison, Heathcote Jenny
Department of Medicine, McMaster University, Hamilton, Ontario.
Can J Gastroenterol. 2003 Aug;17(8):483-7. doi: 10.1155/2003/351816.
Treatment of chronic hepatitis C virus (HCV) infection with interferon alpha-2b and ribavirin is costly in terms of side effects, medical resources and drug costs. Furthermore, less than 50% of patients overall have a sustained virological response (SVR).
To determine if the log fall in HCV RNA between baseline and week 1 (b-wk1) and between baseline and week 4 (b-wk4) after starting treatment could identify the nonresponders.
Sixty-three patients who had completed a full course of therapy were identified. Quantitative measurements of HCV RNA were analyzed from stored sera, collected prospectively.
SVR was achieved in 47.1% and 47.3% of patients in the b-wk1 and b-wk4 groups, respectively. No patients had an SVR with a fall in HCV RNA of less than 0.35 log10 and 1.05 log10 at week 1 and week 4, respectively. This accounted for 44.4% and 51.7% of the nonresponders in the b-wk1 and b-wk4 groups, respectively. Once the decline in viral load was known, genotype, age, sex and baseline viral load did not provide additional power in predicting treatment responses.
A fall of 1.05 log10 in HCV RNA at week 4 predicts those patients who will not respond, identifying one-half of all nonresponders; this allows therapy to be stopped early, without depriving any patient who would have an SVR from treatment.
使用干扰素α-2b和利巴韦林治疗慢性丙型肝炎病毒（HCV）感染，在副作用、医疗资源和药物成本方面代价高昂。此外，总体上不到50%的患者有持续病毒学应答（SVR）。
确定开始治疗后第1周（基线至第1周，b-wk1）和第4周（基线至第4周，b-wk4）时HCV RNA的对数下降是否能识别无应答者。
确定63例完成整个疗程治疗的患者。对前瞻性收集的储存血清进行HCV RNA定量测定分析。
b-wk1组和b-wk4组分别有47.1%和47.3%的患者实现了SVR。分别在第1周和第4周时，HCV RNA下降小于0.35 log10和1.05 log10的患者均未实现SVR。这分别占b-wk1组和b-wk4组无应答者的44.4%和51.7%。一旦知道病毒载量的下降情况，基因型、年龄、性别和基线病毒载量在预测治疗反应方面没有提供额外的作用。
第4周时HCV RNA下降1.05 log10可预测那些无应答的患者，识别出所有无应答者的一半；这使得治疗能够早期停止，而不会剥夺任何本可实现SVR的患者接受治疗的机会。
