聚乙二醇干扰素联合利巴韦林治疗混合基因型 1/2 感染慢性丙型肝炎患者的疗效。

Treatment efficacy of pegylated interferon plus ribavirin therapy in chronic hepatitis C patients with mixed genotype 1/2 infection.

机构信息

Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.

出版信息

J Gastroenterol Hepatol. 2014 May;29(5):1012-8. doi: 10.1111/jgh.12467.

DOI:10.1111/jgh.12467

PMID:24325201

Abstract

BACKGROUND AND AIM

The treatment efficacy of patients with mixed hepatitis C virus (HCV) genotype 1/genotype 2 (HCV-1/2) remains unknown. We aimed to elucidate the sustained virological response (SVR) rate in patients with HCV-1/2 infection.

METHODS

One hundred and ten HCV-1/2 patients treated with response-guided peginterferon/ribavirin therapy (24 weeks for patients with a rapid virological response [RVR] and low viral loads; 48 weeks for patients without a RVR or high viral loads) were allocated. Two hundred HCV-1 patients were selected as a historical control. Interleukin-28B (IL-28B) rs8099917 genotype was tested for the association with an SVR.

RESULTS

The rates of RVR, sustained virologic response (SVR), and relapse rate were 71.8%, 87.3%, and 11.1%, respectively. The SVR rate was significantly higher in patients with an abbreviated regimen as compared with those with 48-week regimen (95.5% vs 75.0%, P = 0.002), and both were similar to the HCV-1 historical control. Stepwise logistic regression analysis revealed that lower baseline viral loads were the single factor predictive of an RVR (odds ratio/95% confidence intervals [OR/CI] of 41.62/9.72-178.19, P < 0.001). The achievement of an RVR was the single best factor predictive of an SVR (OR/CI: 7.5/1.33-42.27, P = 0.02). Nevertheless, an abbreviated regimen became the single factor associated with an SVR if treatment regimen was taken into consideration (OR/CI: 11.0/1.25-96.79, P = 0.03). The SVR rate did not differ between patients with rs8099917 TT and TG/GG genotype (91.7% vs 87.5%, P = 0.63).

CONCLUSIONS

The treatment efficacy of patients with HCV-1/2 was satisfactory. The role of IL-28B genetic variants in the population with response-guided therapy was limited.

摘要

背景与目的

混合丙型肝炎病毒（HCV）基因型 1/2（HCV-1/2）患者的治疗效果尚不清楚。本研究旨在阐明 HCV-1/2 感染患者的持续病毒学应答（SVR）率。

方法

110 例接受基于应答的聚乙二醇干扰素/利巴韦林治疗的 HCV-1/2 患者（RVR 且病毒载量低者治疗 24 周，无 RVR 或病毒载量高者治疗 48 周）被分配。选择 200 例 HCV-1 患者作为历史对照。检测白细胞介素-28B（IL-28B）rs8099917 基因型与 SVR 的相关性。

结果

RVR、持续病毒学应答（SVR）和复发率分别为 71.8%、87.3%和 11.1%。与 48 周疗程相比，短疗程方案的 SVR 率显著更高（95.5%比 75.0%，P=0.002），且与 HCV-1 历史对照相似。逐步逻辑回归分析显示，基线病毒载量较低是 RVR 的唯一预测因素（优势比/95%置信区间[OR/CI]为 41.62/9.72-178.19，P<0.001）。获得 RVR 是 SVR 的最佳预测因素（OR/CI：7.5/1.33-42.27，P=0.02）。然而，如果考虑治疗方案，RVR 是 SVR 的唯一预测因素（OR/CI：11.0/1.25-96.79，P=0.03）。rs8099917 TT 和 TG/GG 基因型患者的 SVR 率无差异（91.7%比 87.5%，P=0.63）。