Li Ya-xin, Yang Yan-jia, Yang Mei, Chen Li-yu, Lu Jia-jie, Ma Yuan-ji, Liu Kai, Lei Xue-zhong, Tang Hong
West China Hospital, Sichuan University, Chengdu, China.
Zhonghua Gan Zang Bing Za Zhi. 2013 May;21(5):345-7. doi: 10.3760/cma.j.issn.1007-3418.2013.05.008.
To evaluate the therapeutic efficacy of antiviral combination therapy with pegylated-interferon alpha-2a plus ribavirin (RBV) in patients with autoantibody-positive chronic hepatitis C (CHC) and to investigate the impact of the presence of autoantibodies on the treatment outcome. Eighty-six consecutive CHC patients who underwent a 48-week treatment regimen composed of Peg-IFNa-2a (135 or 180 mug/wk) plus weight-based RBV ( less than or equal to 65 kg, 800 mg/d; 65 to 75 kg, 1000 mg/d; more than or equal to75 kg, 1200 mg/d ). Prior to treatment (baseline) and at end of treatment (EOT; week 48), levels of antinuclear antibody (ANA), anti-smooth muscle antibody (SMA), anti liver/kidney microsomal antibody type 1 (LKM1), anti-La (SSB), and anti liver cytosolic-1 (LC-1) were detected by indirect immunofluorescence. At baseline, during treatment (weeks 4, 12, 24, and 36), EOT, and 24 weeks after EOT, levels of HCV RNA were assessed by real-time quantitative PCR. Rapid virological response (RVR) was defined as HCV RNA less than 10(3) copy/ml at week 4. Sustained virologic response (SVR) was defined as HCV RNA load below the lower limit of detection at 24 weeks after EOT. Correlation between autoantibodies and treatment-induced reduced HCV RNA load was assessed by univariate analysis of variance or chi-squared tests. Autoantibodies were detected in 24 patients, which included 14 ANA-positive patients, five SMA-positive patients, three LKM1-positive patients, one patient with double-positivity for ANA and SSB, and one patient with double-positivity for ANA and LC-1. The autoantibody-positive patients and autoantibody-negative patients showed similar rates of RVR (70.8% vs. 72.5%, P more than 0.05) and SVR (81.4% vs. 82.2%, P more than 0.05). Antiviral therapy with Peg-IFNa-2a RBV can effectively reduce the HCV RNA load in autoantibody-positive CHC patients; however, the presence of autoantibodies may not be an independent predictor of therapy outcome.
评估聚乙二醇化干扰素α-2a联合利巴韦林（RBV）抗病毒联合治疗对自身抗体阳性慢性丙型肝炎（CHC）患者的疗效，并研究自身抗体的存在对治疗结果的影响。86例连续的CHC患者接受了为期48周的治疗方案，该方案由聚乙二醇化干扰素α-2a（135或180μg/周）加基于体重的RBV（≤65kg，800mg/d；65至75kg，1000mg/d；≥75kg，1200mg/d）组成。在治疗前（基线）和治疗结束时（EOT；第48周），通过间接免疫荧光检测抗核抗体（ANA）、抗平滑肌抗体（SMA）、抗肝肾微粒体1型抗体（LKM1）、抗La（SSB）和抗肝细胞溶质-1（LC-1）的水平。在基线、治疗期间（第4、12、24和36周）、EOT以及EOT后24周，通过实时定量PCR评估HCV RNA水平。快速病毒学应答（RVR）定义为第4周时HCV RNA低于10³拷贝/ml。持续病毒学应答（SVR）定义为EOT后24周时HCV RNA负荷低于检测下限。通过方差分析或卡方检验的单因素分析评估自身抗体与治疗诱导的HCV RNA负荷降低之间的相关性。24例患者检测到自身抗体，其中包括14例ANA阳性患者、5例SMA阳性患者、3例LKM1阳性患者、1例ANA和SSB双阳性患者以及1例ANA和LC-1双阳性患者。自身抗体阳性患者和自身抗体阴性患者的RVR率（70.8%对72.5%，P＞0.05）和SVR率（81.4%对82.2%，P＞0.05）相似。聚乙二醇化干扰素α-2a联合RBV抗病毒治疗可有效降低自身抗体阳性CHC患者的HCV RNA负荷；然而，自身抗体的存在可能不是治疗结果的独立预测指标。
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