Missiha Sharif, Heathcote Jenny, Arenovich Tamara, Khan Kamran
Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Am J Gastroenterol. 2007 Oct;102(10):2181-8. doi: 10.1111/j.1572-0241.2007.01431.x. Epub 2007 Jul 19.
Prior investigation has identified factors associated with response to treatment in hepatitis C including viral genotype and titre, body weight, hepatic fibrosis, and adherence to therapy. The lower response rate of African-Americans relative to whites has been previously described, but studies of other racial or ethnic groups remain limited.
To determine whether Asian race is an independent marker for response to antiviral therapy in hepatitis C.
Data on treatment-naïve patients from a large multicenter study of combination therapy with peginterferon alfa-2a (180 mug SC each week) and ribavirin (800 mg daily) were analyzed retrospectively to identify factors associated with an SVR, defined as an undetectable serum HCV RNA at least 24 wk after completion of therapy.
SVR occurred in 45% of 384 whites and 65% of 52 Asians (P= 0.0047) who were treatment naïve. In a multivariate logistic regression analysis that adjusted for all the aforementioned factors known to be associated with treatment response, Asian race was shown to be an independent predictor of achieving an SVR (OR 2.22, 95% CI 1.11-4.46). Other independent predictors of SVR include viral genotype, body mass index, degree of hepatic fibrosis, and adherence with ribavirin.
Asians are more likely to achieve an SVR to treatment with peginterferon alfa-2a and ribavirin than whites with chronic hepatitis C, suggesting a genetic influence on the antiviral response.
先前的研究已确定了与丙型肝炎治疗反应相关的因素,包括病毒基因型和滴度、体重、肝纤维化以及对治疗的依从性。此前已描述了非裔美国人相对于白人的较低反应率,但对其他种族或族裔群体的研究仍然有限。
确定亚洲种族是否是丙型肝炎抗病毒治疗反应的独立标志物。
对一项关于聚乙二醇化干扰素α-2a(每周皮下注射180μg)联合利巴韦林(每日800mg)联合治疗的大型多中心研究中未经治疗患者的数据进行回顾性分析,以确定与持续病毒学应答(SVR)相关的因素,SVR定义为治疗结束后至少24周血清HCV RNA检测不到。
在384例未经治疗的白人中,45%实现了SVR,在52例亚洲人中这一比例为65%(P = 0.0047)。在一项多因素逻辑回归分析中,对所有已知与治疗反应相关的上述因素进行校正后,亚洲种族被证明是实现SVR的独立预测因素(比值比2.22,95%可信区间1.11 - 4.46)。SVR的其他独立预测因素包括病毒基因型、体重指数、肝纤维化程度以及对利巴韦林的依从性。
与慢性丙型肝炎白人相比,亚洲人使用聚乙二醇化干扰素α-2a和利巴韦林治疗更有可能实现SVR,提示对抗病毒反应存在遗传影响。