[通过快速病毒反应预测慢性丙型肝炎患者对干扰素和利巴韦林联合治疗的持续病毒学应答]

[Prediction of sustained viral response to combinational therapy with interferon and ribavirin in chronic hepatitis C by rapid viral response].

作者信息

Li Ming-hui, Chen Li-jun, Qiu Guo-hua, Lu Yao, Xie Yao, Xu Dao-zhen

机构信息

Beijing Ditan Hospital, Beijing 100011, China.

出版信息

Zhonghua Gan Zang Bing Za Zhi. 2009 Jul;17(7):497-500.

PMID:19912682

Abstract

OBJECTIVE

To evaluate whether the rapid viral response (RVR) to combinational therapy with interferon and rabavirin can be used to predict the sustained viral response (SVR) in chronic hepatitis C patients.

METHODS

According to their clinical characteristics, all patients in this study were given pegylated or conventional interferon injection and different dose of ribavirin according to their weight. Patients were injected Pegasys (pegierferon alpha-2a) 180 microg or 135 microg once a week, or pegyintron 50-80 microg once a week, or conventional interferon 3-5 MU every two days, in combination with a dose of 600-1500 mg/d ribavirin. The serum HCV RNA load was determined at 0, 4, 12 week, and then every 12 weeks. After the viral response obtained, the patients were treated for another 24-72 weeks and followed up 24 weeks. The main parameter to evaluate the efficacy was SVR rate. The influence factors associated with rapid viral response were investigated.

RESULTS

RVR was obtained at week 4 in 84.2% of the 120 patients. The HCV RNA baseline of RVR group was (5.883+/-1.246) lg copies/ml, which was significantly lower than that of the group without RVR [(6.502+/-0.693) lg copies/ml, t=2.15, P=0.034]. 97 patients with RVR who finished treatment and follow-up, 90.7% of these patients obtained SVR, but the SVR rate in patients (82.4%) without RVR was lower than that in patients with RVR (x2=0.371, P=0.543). In this study, RVR rate was not associated with HCV genotype and the dose of interferon used. In the naive patients, the RVR to pegylated interferon was 87.8%, which was significantly higher than that in retreat patients (x2=4.651, P=0.031).

CONCLUSION

High RVR rate could be obtained in chronic hepatitis C patients treated combined with interferon and ribavirin. RVR rate is associated with the HCV RNA baseline load in both naive and retreat patients but not correlated to HCV genotype. RVR could predict the SVR.

摘要

目的

评估慢性丙型肝炎患者对干扰素与利巴韦林联合治疗的快速病毒学应答（RVR）是否可用于预测持续病毒学应答（SVR）。

方法

根据本研究中所有患者的临床特征，给予聚乙二醇化或常规干扰素注射，并根据体重给予不同剂量的利巴韦林。患者每周注射一次派罗欣（聚乙二醇化干扰素α-2a）180微克或135微克，或每周注射一次佩乐能50 - 80微克，或每两天注射一次常规干扰素3 - 5百万单位，同时联合使用剂量为600 - 1500毫克/天的利巴韦林。在第0、4、12周测定血清HCV RNA载量，然后每12周测定一次。获得病毒学应答后，患者再接受24 - 72周的治疗并随访24周。评估疗效的主要参数为SVR率。研究与快速病毒学应答相关的影响因素。

结果

120例患者中，84.2%在第4周获得RVR。RVR组的HCV RNA基线水平为（5.883±1.246）lg拷贝/毫升，显著低于未获得RVR的组[（6.502±0.693）lg拷贝/毫升，t = 2.15，P = 0.034]。97例完成治疗和随访的RVR患者中，90.7%的患者获得SVR，但未获得RVR的患者的SVR率（82.4%）低于获得RVR的患者（x² = 0.371，P = 0.543）。在本研究中，RVR率与HCV基因型及所用干扰素剂量无关。在初治患者中，对聚乙二醇化干扰素的RVR为87.8%，显著高于复治患者（x² = 4.651，P = 0.031）。