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治疗结束应答的慢性丙型肝炎患者复发的危险因素。

Risk factors for relapse in chronic hepatitis C patients who have achieved end of treatment response.

机构信息

Department of Medicine, Kangnam Sacred Hospital, Hallym University, Seoul, Korea.

出版信息

J Gastroenterol Hepatol. 2010 May;25(5):957-63. doi: 10.1111/j.1440-1746.2009.06176.x.

Abstract

BACKGROUND AND AIM

Some patients with chronic hepatitis C experience virologic relapse even after achieving an end of treatment response. Prolonged therapy can be effective for helping such high-risk patients to avoid relapse. We aimed to identify factors predictive of virologic relapse in chronic hepatitis C patients who have achieved end of treatment response.

METHODS

We analyzed data from 242 chronic hepatitis C patients who achieved end of treatment response with peginterferon plus ribavirin therapy from 2003 to 2007.

RESULTS

Virologic relapse was identified in 32 patients (13.2%). We considered age, sex, body mass index, presence of diabetes, hemoglobin, platelet, alanine aminotransferase, stage of fibrosis, baseline hepatitis C virus RNA level, rapid virologic response, and adherence to drugs. For genotype 1 patients, older age (> or = 50 years) and higher baseline RNA level (> or = 2,000,000 IU/mL) were significantly correlated with occurrence of relapse. For genotypes 2 and 3, lower adherence to peginterferon (< 80%) was an independent risk factor for relapse.

CONCLUSIONS

In chronic hepatitis C patients who had achieved end of treatment response, risk factors for relapse were older age and higher baseline hepatitis C virus RNA level in genotype 1, and lower adherence to peginterferon in genotypes 2 and 3, which may be valuable to individualize duration of therapy.

摘要

背景与目的

部分慢性丙型肝炎患者即使在获得治疗结束时的应答后仍会发生病毒学复发。延长治疗可能对帮助此类高危患者避免复发有效。我们旨在确定在获得治疗结束时应答的慢性丙型肝炎患者中,预测病毒学复发的因素。

方法

我们分析了 2003 年至 2007 年间接受聚乙二醇干扰素加利巴韦林治疗并获得治疗结束时应答的 242 例慢性丙型肝炎患者的数据。

结果

32 例患者(13.2%)发生病毒学复发。我们考虑了年龄、性别、体重指数、是否存在糖尿病、血红蛋白、血小板、丙氨酸氨基转移酶、纤维化分期、基线丙型肝炎病毒 RNA 水平、快速病毒学应答和药物依从性。对于基因型 1 患者,年龄较大(≥50 岁)和基线 RNA 水平较高(≥2,000,000IU/mL)与复发的发生显著相关。对于基因型 2 和 3,聚乙二醇干扰素的依从性较低(<80%)是复发的独立危险因素。

结论

在获得治疗结束时应答的慢性丙型肝炎患者中,复发的危险因素为基因型 1 中年龄较大和基线丙型肝炎病毒 RNA 水平较高,以及基因型 2 和 3 中聚乙二醇干扰素的依从性较低,这可能对个体化治疗持续时间有价值。

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