Roeder Claudia, Jordan Sabine, Schulze Zur Wiesch Julian, Pfeiffer-Vornkahl Heike, Hueppe Dietrich, Mauss Stefan, Zehnter Elmar, Stoll Sabine, Alshuth Ulrich, Lohse Ansgar W, Lueth Stefan
Claudia Roeder, Sabine Jordan, Julian Schulze zur Wiesch, Ansgar W Lohse, Stefan Lueth, Department of Medicine I, University Hospital Hamburg Eppendorf, 20246 Hamburg, Germany.
World J Gastroenterol. 2014 Aug 21;20(31):10984-93. doi: 10.3748/wjg.v20.i31.10984.
To evaluate the safety and efficacy of pegylated interferon alfa-2a and ribavirin therapy in elderly patients with chronic hepatitis C infection.
Patients characteristics, treatment results and safety profiles of 4859 patients with hepatitis c virus (HCV) infection receiving treatment with pegylated interferon alfa-2a and ribavirin were retrieved from a large ongoing German multicentre non-interventional study. Recommended treatment duration was 24 wk for GT 2 and GT 3 infection and 48 wk for GT 1 and GT 4 infection. Patients were stratified according to age (< 60 years vs ≥ 60 years). Because of limited numbers of liver biopsies for further assessment of liver fibrosis APRI (aspartate aminotransferase - platelet ratio index) was performed using pre-treatment laboratory data.
Out of 4859 treated HCV patients 301 (6.2%) were ≥ 60 years. There were more women (55.8% vs 34.2%, P < 0.001) and predominantly GT 1 (81.4% vs 57.3%, P < 0.001) infected patients in the group of patients aged ≥ 60 years and they presented more frequently with metabolic (17.6% vs 4.5%, P < 0.001) and cardiovascular comorbidities (32.6% vs 6.7%, P < 0.001) and significant fibrosis and cirrhosis (F3/4 31.1% vs 14.0%, P = 0.0003). Frequency of dose reduction and treatment discontinuation were significantly higher in elderly patients (30.9% vs 13.7%, P < 0.001 and 47.8% vs 30.8%, P < 0.001). Main reason for treatment discontinuation was "virological non-response" (26.6% vs 13.6%). Sustained virological response (SVR) rates showed an age related difference in patients with genotype 1 (23.7% vs 43.7%, P < 0.001) but not in genotype 2/3 infections (57.7% vs 64.6%, P = 0.341). By multivariate analysis, age and stage of liver disease were independent factors of SVR.
Elderly HCV patients differ in clinical characteristics and treatment outcome from younger patients and demand special attention from their practitioner.
评估聚乙二醇化干扰素α-2a联合利巴韦林治疗老年慢性丙型肝炎感染患者的安全性和疗效。
从一项正在进行的大型德国多中心非干预性研究中检索4859例接受聚乙二醇化干扰素α-2a联合利巴韦林治疗的丙型肝炎病毒（HCV）感染患者的特征、治疗结果和安全性资料。推荐的治疗疗程为基因2型和基因3型感染24周，基因1型和基因4型感染48周。患者按年龄分层（<60岁与≥60岁）。由于用于进一步评估肝纤维化的肝活检数量有限，因此使用治疗前实验室数据计算天冬氨酸氨基转移酶-血小板比率指数（APRI）。
在4859例接受治疗的HCV患者中，301例（6.2%）年龄≥60岁。≥60岁患者组中女性更多（55.8%对34.2%，P<0.001），主要为基因1型感染（81.4%对57.3%，P<0.001），且代谢合并症（17.6%对4.5%，P<0.001）、心血管合并症（32.6%对6.7%，P<0.001）以及显著纤维化和肝硬化（F3/4 31.1%对14.0%，P=0.0003）更为常见。老年患者剂量减少和治疗中断的频率显著更高（30.9%对13.7%，P<0.001和47.8%对30.8%，P<0.001）。治疗中断的主要原因是“病毒学无应答”（26.6%对13.6%）。基因1型患者的持续病毒学应答（SVR）率存在年龄相关差异（23.7%对43.7%，P<0.001），但基因2/3型感染患者中无此差异（57.7%对64.6%，P=0.341）。多因素分析显示，年龄和肝病分期是SVR的独立影响因素。
老年HCV患者在临床特征和治疗结果方面与年轻患者不同，需要从业者给予特别关注。
