Suzuki Hideyuki, Kakizaki Satoru, Horiguchi Norio, Ichikawa Takeshi, Sato Ken, Takagi Hitoshi, Mori Masatomo
Hideyuki Suzuki, Satoru Kakizaki, Norio Horiguchi, Takeshi Ichikawa, Ken Sato, Hitoshi Takagi, Masatomo Mori, Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi, Gunma 371-8511, Japan.
World J Hepatol. 2010 Nov 27;2(11):401-5. doi: 10.4254/wjh.v2.i11.401.
To predict which chronic hepatitis C patients are likely to be late-responders, we herein investigated the clinical characteristics of null-responders at 36 wk with hepatitis C virus (HCV) genotype Ib and a high viral load during the course of pegylated interferon (Peg-IFN)/ribavirin therapy.
One hundred forty-two patients with genotype Ib HCV and a high viral load were included in this study. Peg-IFNα2b (1.5 μg/kg once a week) and ribavirin (600-1000 mg per day according to body weight) were administered for 48 wk. We defined null-responders as the cases that never cleared serum HCV RNA as determined using RT-PCR until 36 wk. Other patients were defined as responders. We compared the clinical characteristics (age, gender, body mass index, previous treatment) and HCV RNA titer during the therapy between null-responders and responders.
The HCV RNA clearance rate was 17.9% (24/134), 46.3% (62/134), 60.6% (86/142), 86.6% (123/142), and 88.0% (125/142) at 4, 8, 12, 24, and 36 wk, respectively. There were 17 patients (12.0%) who were still null-responders at 36 wk. There were no differences in the clinical characteristics between the responders and null-responders except for the titer and decline rates of HCV RNA at 1 wk and 4 wk. The HCV RNA titers at 1 wk and after 4 wk of treatment were significantly higher in the null-responders in comparison to the responders (P <0.01). The serum HCV RNA titers of the responders decreased by 1.3 log after 1 wk of treatment, and 1.6 log after 4 wk of treatment, respectively. On the other hand, the titers of the null responders decreased by only 0.5 log after 1 wk, and 0.7 log after 4 wk of treatment, respectively. The decrease rates of HCV RNA after 1 and 4 wk of treatment were significantly worse for null responders than for the responders (P <0.01).
The HCV RNA titer at 1 wk and 4 wk after initiating treatment may be useful for predicting null-responders to Peg-IFNα2b/ribavirin therapy. However, further investigation is needed to determine the optimal time at which the decision to discontinue the Peg-IFNα2b/ribavirin therapy for null-responders can be made.
为预测哪些慢性丙型肝炎患者可能是延迟应答者，我们在此研究了在聚乙二醇化干扰素（Peg-IFN）/利巴韦林治疗过程中，丙型肝炎病毒（HCV）基因Ib型且病毒载量高的患者在36周时无应答者的临床特征。
本研究纳入了142例基因Ib型HCV且病毒载量高的患者。给予Peg-IFNα2b（1.5μg/kg，每周一次）和利巴韦林（根据体重每天600 - 1000mg），治疗48周。我们将无应答者定义为使用逆转录聚合酶链反应（RT-PCR）检测，直至36周血清HCV RNA从未清除的病例。其他患者定义为应答者。我们比较了无应答者和应答者之间的临床特征（年龄、性别、体重指数、既往治疗情况）以及治疗期间的HCV RNA滴度。
在4、8、12、24和36周时，HCV RNA清除率分别为17.9%（24/134）、46.3%（62/134）、60.6%（86/142）、86.6%（123/142）和88.0%（125/142）。有17例患者（12.0%）在36周时仍为无应答者。除了1周和4周时HCV RNA的滴度和下降率外，应答者和无应答者之间的临床特征没有差异。与应答者相比，无应答者在治疗1周和4周后的HCV RNA滴度显著更高（P<0.01）。应答者的血清HCV RNA滴度在治疗1周后下降1.3个对数，在治疗4周后下降1.6个对数。另一方面，无应答者的滴度在治疗1周后仅下降0.5个对数，在治疗4周后下降0.7个对数。治疗1周和4周后，无应答者的HCV RNA下降率显著低于应答者（P<0.01）。
开始治疗后1周和4周时的HCV RNA滴度可能有助于预测对Peg-IFNα2b/利巴韦林治疗无应答者。然而，需要进一步研究以确定对于无应答者停止Peg-IFNα2b/利巴韦林治疗的最佳决策时间。
