聚乙二醇干扰素联合利巴韦林治疗丙型肝炎相关晚期纤维化的持续病毒学应答率：一项真实世界研究。
Peginterferon plus ribavirin and sustained virological response rate in HCV-related advanced fibrosis: a real life study.
机构信息
Botucatu School of Medicine, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil.
Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
出版信息
Braz J Infect Dis. 2014 Jan-Feb;18(1):48-52. doi: 10.1016/j.bjid.2013.05.007. Epub 2013 Sep 20.
BACKGROUND
Tolerance and response to antiviral HCV treatment is poor in advanced fibrosis. The aim of this study was to assess SVR rate and its predictive factors in HCV advanced fibrosis patients treated in real life with full dose PEG-IFN plus RBV and to evaluate the adverse events related to treatment.
METHODS
A multicentric, retrospective study was conducted at six university hospitals. METAVIR F3 and F4 HCV monoinfected patients who were treated with PEG-IFN and RBV had their data analyzed. A stepwise logistic regression analysis was performed to identify the variables independently related to SVR. Adverse events were recorded during treatment.
RESULTS
308 patients were included, 75% genotype 1 and 23% genotype 3. METAVIR F3 was present in 39% and F4 in 61% of patients. The median Child Pugh score for F4 patients was 5 (5-9). The global SVR rate was 34%, 11% were relapsers and 55% were nonresponders. SVR rates were similar between patients treated with PEG-IFN alfa 2a or alfa 2b (p=0.24). SVR rates according to Child-Pugh score were 26% (Child A) and 18% (Child B). The independent factors related to SVR in F4 patients were genotype 3, RVR and fewer Child Pugh score points. Treatment interruption occurred in 31% patients and death occurred in 1.9%, all with liver cirrhosis.
CONCLUSION
Treatment of HCV in patients with advanced fibrosis should not be postponed. However, a very careful evaluation of cirrhotic patients must be performed before treatment is indicated and careful monitoring is required during treatment.
背景
在晚期纤维化中，对抗病毒 HCV 治疗的耐受性和反应较差。本研究的目的是评估在现实生活中用全剂量 PEG-IFN 加 RBV 治疗 HCV 晚期纤维化患者的 SVR 率及其预测因素，并评估与治疗相关的不良事件。
方法
在六所大学医院进行了一项多中心、回顾性研究。对接受 PEG-IFN 和 RBV 治疗的 METAVIR F3 和 F4 HCV 单感染患者进行数据分析。采用逐步逻辑回归分析确定与 SVR 独立相关的变量。记录治疗期间的不良事件。
结果
共纳入 308 例患者，75%为基因型 1，23%为基因型 3。METAVIR F3 占 39%，F4 占 61%。F4 患者的中位 Child Pugh 评分为 5（5-9）。全球 SVR 率为 34%，11%为复发，55%为无应答。用 PEG-IFN alfa 2a 或 alfa 2b 治疗的患者 SVR 率相似（p=0.24）。根据 Child-Pugh 评分的 SVR 率分别为 26%（Child A）和 18%（Child B）。F4 患者与 SVR 相关的独立因素为基因型 3、RVR 和较少的 Child Pugh 评分点。31%的患者中断治疗，1.9%的患者死亡，均患有肝硬化。
结论
不应推迟对晚期纤维化患者的 HCV 治疗。然而，在开始治疗之前，必须对肝硬化患者进行非常仔细的评估，并在治疗过程中进行仔细监测。
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