Li Ming-Hui, Zhang Yan-Li, Zhang Lu, Shen Ge, Qiu Guo-Hua, Lu Yao, Zhuang Li-Wei, Gao Yuan-Jiao, Yang Min, Wu Yun, Xie Yao, Cheng Jun, Xu Daozhen
Liver Diseases Center, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China.
Zhonghua Shi Yan He Lin Chuang Bing Du Xue Za Zhi. 2012 Oct;26(5):374-8.
To explore the effect of intensive treatment for refractory chronic hepatitis C, and to improve the sustained viral response (SVR) rate of treatment with interferon plus ribavirin by optimizing therapeutic dose and course.
Patients who did not acquire response or partial response by standard therapy (PEG-IFN alpha subcutaneous injection weekly plus Ribavirin 10.5 mg/kg) every day were enrolled and retreated with intensive treatment of 10 MU interferon every other day or 360 microg pegylated interferon alpha-2a weekly according to patients' wishes, and ribavirin 15 mg/kg every day. Serum HCV RNA was detected at baseline,treatment week 4, 12 and every 12 weeks succedent and 24 weeks after treatment end. Course of treatment was 72 to 96 weeks according to viral response. SVR was the mark of therapeutic effect.
18 patients completed whole range therapy and follow-up, in which 12 patients acquired SVR, 5 patients treatment failure and 1 relapse. 3 patients acquired rapid viral response (RVR), and they all got complete Early Viral Response (cEVR) and SVR. RVR Patients' viral loads were significantly lower than that of patients who did not acquire RVR (t = 4. 687, P < 0.001). In 15 patients who did not acquire RVR, 8 patients acquired cEVR, and 9 acquired SVR. SVR rate of patients who were administered PEG-IFN alpha-2a was 4/5, 11 patients who acquired cEVR all acquired SVR, while in 7 patients who did not acquire cEVR, only 1 patient acquired SVR.
High percent patients, who did not acquire response or partial response by previous standard antiviral therapy, could gain SVR by intensive dose interferon plus Ribavirin. In intensive treatment procedure, adjusting and prolonging course according to viral response after HCV RNA turned negative were important measures to improve refractory Chronic Hepatitis C SVR rate.
探讨强化治疗对难治性慢性丙型肝炎的疗效，通过优化治疗剂量和疗程提高干扰素联合利巴韦林治疗的持续病毒学应答（SVR）率。
入选经标准治疗（聚乙二醇干扰素α皮下注射每周1次加利巴韦林每日10.5mg/kg）未获得应答或部分应答的患者，根据患者意愿，采用强化治疗方案，即干扰素隔日10MU或聚乙二醇干扰素α-2a每周360μg，利巴韦林每日15mg/kg。于基线、治疗第4周、12周及后续每12周、治疗结束后24周检测血清HCV RNA。根据病毒应答情况，治疗疗程为72至96周。以SVR作为治疗效果的指标。
18例患者完成全程治疗及随访，其中12例获得SVR，5例治疗失败，1例复发。3例获得快速病毒学应答（RVR），均获得完全早期病毒学应答（cEVR）及SVR。RVR患者的病毒载量显著低于未获得RVR的患者（t = 4.687，P < 0.001）。在15例未获得RVR的患者中，8例获得cEVR，9例获得SVR。接受聚乙二醇干扰素α-2a治疗的患者SVR率为4/5，11例获得cEVR的患者均获得SVR，而在7例未获得cEVR的患者中，仅1例获得SVR。
既往标准抗病毒治疗未获得应答或部分应答的患者中，较高比例可通过高剂量干扰素联合利巴韦林获得SVR。在强化治疗过程中，根据HCV RNA转阴后的病毒应答调整并延长疗程是提高难治性慢性丙型肝炎SVR率的重要措施。
