Dai Chia-Yen, Chuang Wan-Long, Chang Wen-Yu, Chen Shinn-Cherng, Lee Li-Po, Hsieh Ming-Yen, Hou Nei-Jen, Lin Zu-Yau, Hsieh Ming-Yuh, Wang Liang-Yen, Yu Ming-Lung
Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan, China.
World J Gastroenterol. 2005 Jul 21;11(27):4241-5. doi: 10.3748/wjg.v11.i27.4241.
The clinical significance of co-infection of SENV-D among patients with chronic hepatitis C (CHC) and response of both viruses to combination therapy with high-dose interferon-alfa (IFN) plus ribavirin remain uncertain and are being investigated.
Total 164 (97 males and 67 females, the mean age 48.1+/-11.4 years, range: 20-73 years, 128 histologically proved) naive CHC patients were enrolled in this study. SENV-D DNA was tested by PCR method. Detection of serum HCV RNA was performed using a standardized automated qualitative RT-PCR assay (COBAS AMPLICOR HCV Test, version 2.0). HCV genotypes 1a, 1b, 2a, 2b, and 3a were determined by using genotype-specific primers. Pretreatment HCV RNA levels were determined by using the branched DNA assay (Quantiplex HCV RNA 3.0). There are 156 patients receiving combination therapy with IFN 6 MU plus ribavirin for 24 wk and the response to therapy is determined.
Sixty-one (37.2%) patients were positive for SENV-D DNA and had higher mean age than those who were negative (50.7+/-10.6 years vs 46.6+/-11.6 years, P = 0.026). The rate of sustained viral response (SVR) for HCV and SENV-D were 67.3% (105/156) and 56.3% (27/48), respectively. By univariate analysis, the higher rate of SVR was significantly related to HCV genotype non-1b (P<0.001), younger ages (P = 0.014), lower pretreatment levels of HCV RNA (P = 0.019) and higher histological activity index (HAI) score for intralobular regeneration and focal necrosis (P = 0.037). By multivariate analyses, HCV genotype non-1b, younger age and lower pretreatment HCV RNA levels were significantly associated with HCV SVR (odds ratio (OR)/95% confidence interval (CI): 12.098/0.02-0.19, 0.936/0.890-0.998, and 3.131/1.080-9.077, respectively). The SVR of SENV-D was higher among patients clearing SENV-D than those who had viremia at the end of therapy (P = 0.04).
Coexistent SENV-D infection, apparently associated with higher ages, is found in more than one-third Taiwanese CHC patients. Both HCV and SENV-D are highly susceptible to combination therapy with high-dose IFN and ribavirin and SENV-D co-infection does not affect the HCV response. HCV genotype, pretreatment HCV RNA levels and age are predictive factors for HCV SVR.
慢性丙型肝炎（CHC）患者中SENV-D合并感染的临床意义以及两种病毒对大剂量干扰素-α（IFN）联合利巴韦林治疗的反应仍不确定，正在进行研究。
本研究纳入了164例初治CHC患者（97例男性和67例女性，平均年龄48.1±11.4岁，范围：20 - 73岁，128例经组织学证实）。采用PCR方法检测SENV-D DNA。使用标准化的自动化定性RT-PCR检测法（COBAS AMPLICOR HCV检测，2.0版）检测血清HCV RNA。使用基因型特异性引物确定HCV基因型1a、1b、2a、2b和3a。采用分支DNA检测法（Quantiplex HCV RNA 3.0）测定治疗前HCV RNA水平。156例患者接受IFN 6 MU联合利巴韦林治疗24周，并确定治疗反应。
61例（37.2%）患者SENV-D DNA呈阳性，其平均年龄高于阴性患者（50.7±10.6岁对46.6±11.6岁，P = 0.026）。HCV和SENV-D的持续病毒学应答（SVR）率分别为67.3%（105/156）和56.3%（27/48）。单因素分析显示，较高的SVR率与非1b型HCV基因型显著相关（P<0.001）、年龄较小（P = 0.014）、治疗前HCV RNA水平较低（P = 0.019）以及小叶内再生和局灶性坏死的组织学活动指数（HAI）评分较高（P = 0.037）。多因素分析显示，非1b型HCV基因型、年龄较小和治疗前HCV RNA水平较低与HCV SVR显著相关（优势比（OR）/95%置信区间（CI）：分别为12.098/0.02 - 0.19、0.936/0.890 - 0.998和3.131/1.080 - 9.077）。治疗结束时清除SENV-D的患者中SENV-D的SVR高于仍有病毒血症的患者（P = 0.04）。
在超过三分之一的台湾CHC患者中发现了与较高年龄明显相关的SENV-D合并感染。HCV和SENV-D对大剂量IFN和利巴韦林联合治疗均高度敏感，SENV-D合并感染不影响HCV反应。HCV基因型、治疗前HCV RNA水平和年龄是HCV SVR的预测因素。
