[个体化治疗方案对慢性丙型肝炎的影响及病毒学应答的影响因素]

[The effects of individualized therapeutic programs on chronic hepatitis C and the influential factors of virological response].

作者信息

Cheng Mao-liang, Wang Jue, Zeng Ai-ping, Liu Xue-feng

机构信息

Department of Clinical Laboratory, the Affiliated Wenling Hospital of Wenzhou Medical College, Zhejiang 317500, China.

出版信息

Zhonghua Nei Ke Za Zhi. 2012 Oct;51(10):751-4.

PMID:23290969

Abstract

OBJECTIVE

To investigate the effect of individualized therapeutic programs with combination of interferon and ribavirin (RBV) in chronic hepatitis C (CHC) and study the influential factors of virological response rates.

METHODS

A total of 139 patients with CHC were enrolled and given the intensive treatment doses of interferon and RBV according to their basic clinical condition. At the treatment of 0, 4, 12, 24 weeks, the end of treatment and 24 weeks after treatment stop, the serum HCV RNA was determined. Timely adjustment to dosage and time periods was made according to the virological response to treatment, and the predictive value of rapid virological response (RVR) and complete early virological response (cEVR) for sustained virological response (SVR) were analyzed.

RESULTS

At the 4th week of treatment, the level of serum HCV RNA was monitored in 120 patients, and 84.2% (101/120) of patients obtained RVR; among them, 90.7% (88/97) obtained SVR. The virus load of patients obtained RVR at pretherapy was lower than that of patients didn't obtained RVR [(5.883 ± 1.246) lg copies/ml vs(6.502 ± 0.693) lg copies/ml, P = 0.034]. The RVR rate of initial treatment patients with PEG-IFNα-2a [87.8% (79/90)] was significantly higher than that of retreatment patients with PEG-IFNα-2a [65.0% (13/20)] (P = 0.031). At the 12th week of treatment, the level of serum HCV RNA was monitored in 132 patients, and 92.4% (122/132) of patients obtained cEVR; among them, 90.8% (108/119) obtained SVR. The SVR rate of patients obtained cEVR was significantly higher than that of patients didn't obtained cEVR (5/9) (P = 0.007). There was no significant difference between the cEVR rate of initial treatment patients [94.7% (90/95)] and retreatment patients [85% (17/20)] with PEG-IFNα-2a (P = 0.158).

CONCLUSIONS

cEVR was predictor of SVR. Individualized therapy can increase the obtaining probability of RVR, cEVR and SVR. Adjusting drug dose timely and extending treatment period of HCV RNA-negative based on virological response to treatment are important in CHC individualized therapy.

摘要

目的

探讨干扰素联合利巴韦林（RBV）个体化治疗方案对慢性丙型肝炎（CHC）的疗效，并研究病毒学应答率的影响因素。

方法

共纳入139例CHC患者，根据其基本临床情况给予干扰素和RBV强化治疗剂量。在治疗0、4、12、24周、治疗结束时及治疗停止后24周，测定血清HCV RNA。根据治疗的病毒学应答及时调整剂量和疗程，并分析快速病毒学应答（RVR）和完全早期病毒学应答（cEVR）对持续病毒学应答（SVR）的预测价值。

结果

治疗第4周时，对120例患者进行血清HCV RNA水平监测，84.2%（101/120）的患者获得RVR；其中，90.7%（88/97）的患者获得SVR。获得RVR的患者治疗前病毒载量低于未获得RVR的患者[（5.883±1.246）lg拷贝/ml vs（6.502±0.693）lg拷贝/ml，P = 0.034]。聚乙二醇干扰素α-2a初始治疗患者的RVR率[87.8%（79/90）]显著高于聚乙二醇干扰素α-2a再次治疗患者[65.0%（13/20）]（P = 0.031）。治疗第12周时，对132例患者进行血清HCV RNA水平监测，92.4%（122/132）的患者获得cEVR；其中，90.8%（108/119）的患者获得SVR。获得cEVR的患者SVR率显著高于未获得cEVR的患者（5/9）（P = 0.007）。聚乙二醇干扰素α-2a初始治疗患者[94.7%（90/95）]和再次治疗患者[85%（17/20）]的cEVR率差异无统计学意义（P = 0.158）。