Jung Chang Ho, Um Soon Ho, Kim Tae Hyung, Yim Sun Young, Suh Sang Jun, Yim Hyung Joon, Seo Yeon Seok, Choi Hyuk Soon, Chun Hoon Jai
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
Gut Liver. 2016 Sep 15;10(5):808-17. doi: 10.5009/gnl15360.
BACKGROUND/AIMS: Peginterferon plus ribavirin remains a standard therapy for patients with chronic hepatitis C (CHC) in Korea. We investigated the efficacy and long-term outcome of peginterferon and ribavirin therapy in Korean patients with CHC, particularly in relation to the stage of liver fibrosis.
The incidence of sustained virological response (SVR), hepatic decompensation, hepatocellular carcinoma, and liver-related death was analyzed in 304 patients with CHC; the patients were followed up for a median of 54 months.
Among patients with HCV genotype 1, the SVR rate was 36.7% (18/49) and 67% (69/103) for patients with and without cirrhosis, respectively (p<0.001). For patients with non-1 HCV genotypes, the SVR rates were 86.0% (37/43) in cirrhotic patients and 86.2% (94/109) in noncirrhotic patients. SVR significantly reduced the risk of liverrelated death, hepatic decompensation, and hepatocellular carcinoma, which had hazard ratios of 0.27, 0.16, and 0.22, respectively (all p<0.05). However, despite the SVR rate, patients with advanced fibrosis were still at risk of developing liver-related complications.
A relatively high SVR rate was achieved by peginterferon plus ribavirin therapy in Korean patients with CHC, which improved their long-term outcomes. However, all CHC patients with advanced hepatic fibrosis should receive close follow-up observations, even after successful antiviral treatment.
背景/目的:聚乙二醇干扰素联合利巴韦林仍是韩国慢性丙型肝炎(CHC)患者的标准治疗方案。我们研究了聚乙二醇干扰素和利巴韦林治疗韩国CHC患者的疗效及长期预后,尤其与肝纤维化阶段的关系。
分析304例CHC患者的持续病毒学应答(SVR)、肝失代偿、肝细胞癌及肝脏相关死亡的发生率;患者中位随访54个月。
在丙型肝炎病毒(HCV)基因1型患者中,肝硬化患者和非肝硬化患者的SVR率分别为36.7%(18/49)和 $67%$(69/103)($p<0.001$)。对于非1型HCV基因型患者,肝硬化患者和非肝硬化患者的SVR率分别为86.0%(37/43)和86.2%(94/109)。SVR显著降低了肝脏相关死亡、肝失代偿和肝细胞癌的风险,风险比分别为0.27、0.16和0.22(均 $p<0.05$)。然而,尽管有SVR率,但晚期纤维化患者仍有发生肝脏相关并发症的风险。
聚乙二醇干扰素联合利巴韦林治疗韩国CHC患者可获得相对较高的SVR率,改善了他们的长期预后。然而,所有晚期肝纤维化的CHC患者即使在抗病毒治疗成功后也应接受密切随访观察。