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慢性丙型肝炎患者对干扰素治疗反应的预后因素分析

Analysis of prognostic factors in therapeutic responses to interferon in patients with chronic hepatitis C.

作者信息

Hosogaya Shigemi, Ozaki Yukio, Enomoto Nobuyuki, Akahane Yoshihiro

机构信息

Department of Clinical and Laboratory Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan.

出版信息

Transl Res. 2006 Aug;148(2):79-86. doi: 10.1016/j.trsl.2006.03.004.

Abstract

The genotype of hepatitis C virus (HCV) and the amount of HCV RNA are often used to predict the efficacy of interferon (IFN) therapy on chronic hepatitis C. In addition to these factors, there may be several factors related to the host. Therefore, the authors undertook a retrospective study in which physical findings and laboratory data before therapy were evaluated by multiple logistic analysis. Two-hundred and five cases with chronic hepatitis C treated with interferon were analyzed in this study. Sustained virological response was observed with 68 cases. Multiple logistic analysis was performed with 29 explanatory variables including HCV genotype, HCV RNA, IFN types, and total dose, along with gender, age, alcohol consumption, body mass index (BMI), histological findings of liver biopsy, platelet counts, and laboratory data of serum enzymes. Analysis on the factors that correlated well with therapeutic efficacy revealed that genotype 2a, 2b showed higher therapeutic responses than genotype 1b with reference to HCV genotypes, and higher IFN dose or lower HCV RNA levels gave better results. With reference to host factors, higher total protein level, lower levels of BMI, total bilirubin, and aspartate aminotransferase were highly correlated with therapeutic efficacy. HCV genotypes and HCV RNA levels have been already identified as prognostic factors. However, the high correlation values of BMI and the total protein level are new findings. It is suggested that probability estimation of therapeutic effects using the logistic regression equation may be a good tool for predicting therapeutic efficacy of IFN therapy on individual cases.

摘要

丙型肝炎病毒(HCV)的基因型和HCV RNA量常被用于预测干扰素(IFN)治疗慢性丙型肝炎的疗效。除了这些因素外,可能还有一些与宿主相关的因素。因此,作者进行了一项回顾性研究,通过多因素逻辑分析评估治疗前的体格检查结果和实验室数据。本研究分析了205例接受干扰素治疗的慢性丙型肝炎患者。68例患者出现持续病毒学应答。对包括HCV基因型、HCV RNA、IFN类型和总剂量在内的29个解释变量,以及性别、年龄、饮酒量、体重指数(BMI)、肝活检组织学结果、血小板计数和血清酶实验室数据进行了多因素逻辑分析。对与治疗效果相关性良好的因素分析显示,就HCV基因型而言,2a型、2b型基因型的治疗反应高于1b型,较高的IFN剂量或较低的HCV RNA水平效果更好。就宿主因素而言,较高的总蛋白水平、较低的BMI、总胆红素和天冬氨酸转氨酶水平与治疗效果高度相关。HCV基因型和HCV RNA水平已被确定为预后因素。然而,BMI和总蛋白水平的高相关性是新发现。提示使用逻辑回归方程估计治疗效果的概率可能是预测IFN治疗个体病例疗效的良好工具。

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