聚乙二醇化干扰素-α与利巴韦林联合治疗慢性丙型肝炎感染患者持续病毒学应答的预测
Prediction of sustained virologic responses to combination therapy of pegylated interferon-α and ribavirin in patients with chronic hepatitis C infection.
作者信息
Ismail Mona H
机构信息
Department of Internal Medicine, Division of Gastroenterology, University of Dammam, College of Medicine, King Fahd Hospital of the University, Al-Khobar, Saudi Arabia.
出版信息
J Family Community Med. 2013 Jan;20(1):35-40. doi: 10.4103/2230-8229.108182.
BACKGROUND AND AIM
Hepatitis C virus (HCV) infection is a major health problem worldwide. Genotype-4 is the most common genotype in Saudi Arabia. The response to treatment with pegylated interferon-α combined with ribavirin in chronic HCV infection varies. This study aimed at investigating the pre- and on-treatment predictors of sustained virologic response (SVR) in patients with chronic hepatitis C (CHC) infection.
PATIENTS AND METHODS
Clinical data of 48 patients with CHC treated with standard HCV antiviral combination therapy, between January 2005 and December 2010, at a Saudi University hospital, were retrospectively reviewed for age, sex, body mass index, liver enzymes, HCV-RNA viral load, liver biopsy, and response to treatment. The primary end point was SVR defined as undetectable HCV-RNA by polymerase chain reaction (PCR) 24 weeks after the end of treatment. Univariable logistic regression was used to explore the association between the different variables and SVR. These independent predictors of SVR were then analyzed with multivariable logistic regression analysis.
RESULTS
Of the 48 treated patients, 25 (52%) were females and 27 (56%) were Saudi. The mean age was 43 years (43 ± 10 years). Twenty-four (50%) had genotype-4, and 26 (54%) had liver biopsy. The overall SVR rate was 75% (36/48) and was 83.3% (20/24) among genotype-4 patients. Baseline factors associated with SVR identified by univariate logistic regression were genotype-4 and early viral response (EVR), defined as a drop of ≥2 log in serum HCV viral load after 12 weeks of initiation of combination therapy (P = 0.001). However, in stepwise regression analysis, the independent factor associated with the effect of antiviral therapy was genotype-4. When on-treatment variables were included, EVR (P = 0.003) and low baseline viral load (P = 0.048) were highly predictive of SVR.
CONCLUSIONS
Of our HCV-treated patients, 75% had SVR. HCV genotype-4, EVR, and low baseline viral load were predictive of SVR.
背景与目的
丙型肝炎病毒（HCV）感染是全球主要的健康问题。4型是沙特阿拉伯最常见的基因型。聚乙二醇化干扰素-α联合利巴韦林治疗慢性HCV感染的疗效各异。本研究旨在调查慢性丙型肝炎（CHC）感染患者持续病毒学应答（SVR）的治疗前和治疗中预测因素。
患者与方法
回顾性分析2005年1月至2010年12月在沙特一所大学医院接受标准HCV抗病毒联合治疗的48例CHC患者的临床资料，包括年龄、性别、体重指数、肝酶、HCV-RNA病毒载量、肝活检及治疗反应。主要终点为SVR，定义为治疗结束后24周通过聚合酶链反应（PCR）检测不到HCV-RNA。采用单变量逻辑回归分析不同变量与SVR之间的关联。然后对这些SVR的独立预测因素进行多变量逻辑回归分析。
结果
48例接受治疗的患者中，25例（52%）为女性，27例（56%）为沙特人。平均年龄为43岁（43±10岁）。24例（50%）为4型基因型，26例（54%）进行了肝活检。总体SVR率为75%（36/48），4型基因型患者的SVR率为83.3%（20/24）。单变量逻辑回归确定的与SVR相关的基线因素为4型基因型和早期病毒应答（EVR），EVR定义为联合治疗开始12周后血清HCV病毒载量下降≥2 log（P = 0.001）。然而，在逐步回归分析中，与抗病毒治疗效果相关的独立因素是4型基因型。纳入治疗中变量后，EVR（P = 0.003）和低基线病毒载量（P = 0.048）对SVR具有高度预测性。
结论
在我们接受HCV治疗的患者中，75%实现了SVR。HCV 4型基因型、EVR和低基线病毒载量可预测SVR。
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