聚乙二醇干扰素 α-2a 和利巴韦林治疗老年慢性丙型肝炎的疗效及影响因素。
Efficacy and factors influencing treatment with peginterferon alpha-2a and ribavirin in elderly patients with chronic hepatitis C.
机构信息
Department of Infectious Diseases, Second Affiliated Hospital, Harbin Medical University, Harbin 150086, China.
出版信息
Hepatobiliary Pancreat Dis Int. 2012 Apr;11(2):185-92. doi: 10.1016/s1499-3872(12)60146-5.
BACKGROUND
In China, hepatitis C virus (HCV) infection is characterized by an increasing prevalence during aging. This study was undertaken to evaluate the efficacy of treatment with peginterferon alpha-2a and ribavirin in elderly chronic hepatitis C (CHC) patients and study the factors related to the sustained virologic response (SVR).
METHODS
The medical records of 417 patients treated with peginterferon and ribavirin were retrospectively analyzed. These patients were divided into two groups according to age: patients aged ≥ 65 years (n=140) and patients aged <65 years (n=277). The rate of ribavirin reduction or discontinuation and virologic response rates of the two groups were compared. The factors influencing SVR were studied by multivariate analysis.
RESULTS
Ribavirin reduction or discontinuation was more frequent in patients aged ≥ 65 years than patients aged <65 years (37.1%, 52/140 vs 20.2%, 56/277; X2=13.883, P<0.001). For genotype 1, patients aged ≥ 65 years had a higher relapse rate (50.0%, 42/84 vs 29.2%, 52/178; X2=10.718, P=0.001) and a lower SVR rate (40.0%, 42/105 vs 60.0%, 126/210; X2=11.250, P=0.001) than patients aged <65 years. There were no significant differences in virologic response rates between the two groups for patients with genotype 2. For genotype 1, in patients aged ≥ 65 years, the SVR rate of females was lower than that of males (28.6%, 12/42 vs 47.6%, 30/63; X2=8.150, P=0.004); in the high viral load group, patients aged ≥ 65 years had a lower SVR rate than patients aged <65 years (30.0%, 18/60 vs 54.8%, 69/126; X2=10.010, P=0.002). In multivariate logistic regression analysis, the independent factors associated with SVR in patients aged ≥ 65 years were sex (P=0.020), genotype (P=0.005), ribavirin reduction or discontinuation (P=0.009) and presence of rapid virologic response (RVR) (P=0.001).
CONCLUSIONS
The rate of ribavirin reduction or discontinuation and relapse rate of patients aged ≥ 65 years with genotype 1 are high, and the SVR rate is low. Age has no impact on virologic responses rates for genotype 2. Among patients ≥ 65 years old, genotype 2 patients and genotype 1 patients with a low baseline viral load or achieving RVR or male may benefit from combination therapy.
背景
在中国，丙型肝炎病毒（HCV）感染的特点是随着年龄的增长而流行率增加。本研究旨在评估聚乙二醇干扰素α-2a 和利巴韦林治疗老年慢性丙型肝炎（CHC）患者的疗效，并研究与持续病毒学应答（SVR）相关的因素。
方法
回顾性分析了 417 例接受聚乙二醇干扰素和利巴韦林治疗的患者的病历。根据年龄将这些患者分为两组：年龄≥65 岁的患者（n=140）和年龄<65 岁的患者（n=277）。比较两组的利巴韦林减量或停药率和病毒学应答率。通过多因素分析研究影响 SVR 的因素。
结果
年龄≥65 岁的患者比年龄<65 岁的患者更频繁地减少或停止使用利巴韦林（37.1%，52/140 与 20.2%，56/277；X2=13.883，P<0.001）。对于基因型 1，年龄≥65 岁的患者复发率更高（50.0%，42/84 与 29.2%，52/178；X2=10.718，P=0.001），SVR 率更低（40.0%，42/105 与 60.0%，126/210；X2=11.250，P=0.001）。对于基因型 2 的患者，两组之间的病毒学应答率没有显著差异。对于基因型 1，年龄≥65 岁的患者中，女性的 SVR 率低于男性（28.6%，12/42 与 47.6%，30/63；X2=8.150，P=0.004）；在高病毒载量组中，年龄≥65 岁的患者的 SVR 率低于年龄<65 岁的患者（30.0%，18/60 与 54.8%，69/126；X2=10.010，P=0.002）。在多因素逻辑回归分析中，与年龄≥65 岁患者 SVR 相关的独立因素为性别（P=0.020）、基因型（P=0.005）、利巴韦林减量或停药（P=0.009）和快速病毒学应答（RVR）（P=0.001）。
结论
年龄≥65 岁的基因型 1 患者利巴韦林减量或停药率和复发率较高，SVR 率较低。年龄对基因型 2 的病毒学应答率没有影响。在年龄≥65 岁的患者中，基因型 2 患者和基线病毒载量较低或达到 RVR 或男性的基因型 1 患者可能从联合治疗中获益。
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