Wada Yuki, Tamai Hideyuki, Kawashima Akira, Shingaki Naoki, Mori Yoshiyuki, Kawaguchi Masanori, Moribata Kosaku, Deguchi Hisanobu, Ueda Kazuki, Inoue Izumi, Maekita Takao, Iguchi Mikitaka, Kato Jun, Ichinose Masao
Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan.
Department of Internal Medicine, Naga Municipal Hospital, Kinokawa, Japan.
Gut Liver. 2014 Jul;8(4):421-7. doi: 10.5009/gnl.2014.8.4.421. Epub 2014 Apr 23.
BACKGROUND/AIMS: The present study aimed to clarify whether virological response within 2 weeks after therapy initiation can predict a null response to pegylated interferon α-2b plus ribavirin therapy in patients with high viral load genotype 1b hepatitis C.
The participants consisted of 72 patients with high viral load genotype 1b. The dynamics of viral load within 2 weeks were measured.
Significant differences between null responders and nonnull responders were noted for interleukin (IL)-28B genotype, amino acid 70 substitution, α-fetoprotein, low-density lipoprotein cholesterol, hyaluronic acid, and viral response. The area under the curve (AUC) for the receiver operating characteristic curve of the hepatitis C virus (HCV) RNA level decline at 2 weeks (AUC=0.993) was the highest among the factors predicting the null response. When the cutoff value for the HCV RNA level decline at 2 weeks was set at 0.80 log, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in predicting a null response were 82%, 96%, 82%, 96%, and 94%, respectively. In comparison, values for the non-TT and mutant type of amino acid 70 substitution were similar to those for HCV RNA level decline at 2 weeks.
Virological response at 2 weeks or the combination of IL-28B and amino acid 70 substitution are accurate predictors of a null response.
背景/目的：本研究旨在明确在高病毒载量基因1b型丙型肝炎患者中，治疗开始后2周内的病毒学应答是否可预测聚乙二醇化干扰素α-2b联合利巴韦林治疗的无应答情况。
研究对象为72例高病毒载量基因1b型患者。测定2周内病毒载量的动态变化。
无应答者与非无应答者在白细胞介素（IL）-28B基因型、氨基酸70位点替换、甲胎蛋白、低密度脂蛋白胆固醇、透明质酸及病毒应答方面存在显著差异。丙型肝炎病毒（HCV）RNA水平在2周时下降情况的受试者工作特征曲线下面积（AUC=0.993）在预测无应答的因素中最高。当将2周时HCV RNA水平下降的截断值设定为0.80 log时，预测无应答的敏感性、特异性、阳性预测值、阴性预测值及准确性分别为82%、96%、82%、96%及94%。相比之下，非TT型及氨基酸70位点替换的突变型的值与2周时HCV RNA水平下降的值相似。
2周时的病毒学应答或IL-28B与氨基酸70位点替换的联合是无应答的准确预测指标。
