Ekstrom Victoria, Kumar Rajneesh, Zhao Yi, Yee Mei Ling, Sung Cynthia, Toh Dorothy, Loh Poh Yen, Tan Jessica, Teo Eng Kiong, Chow Wan Cheng
Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore.
Department of Clinical Translational Research, Singapore General Hospital, Singapore.
Gastroenterol Rep (Oxf). 2017 Aug;5(3):208-212. doi: 10.1093/gastro/gow033. Epub 2016 Oct 24.
Conventional hepatitis C treatment using pegylated interferon (PEG-IFN) and ribavirin is associated with significant side effects. polymorphism can predict response to treatment, with CC genotype having a better response. gene deficiency protects against clinically significant anaemia induced by treatment. The purpose of this study was to determine polymorphism and variation among hepatitis C genotype 1 patients who have undergone therapy with PEG-IFN and ribavirin and their association with sustained viral response (SVR). All hepatitis C genotype 1 patients who had been treated with PEG-IFN and ribavirin over the past 10 years were identified by available medical records and were contacted by letter of invitation to participate in the study. Blood samples for and genotyping were obtained. Medical records were reviewed for verification of treatment response, development of anaemia and if treatment reduction was required during the treatment. A total of 61 patients with hepatitis C genotype 1 were treated with PEG-IFN and ribavirin, of whom 42 agreed to participate in the study. Mean age was 45.6±12.9 years at time of treatment, and 83.3% of patients were males. Thirty-three (78.6%) had CC genotype, of whom 25 (75.8%) obtained SVR compared with only 3 of 9 (33.3%) non C/C genotype patients who achieved SVR (=0.041). Eleven (26.1%) patients had AC genotype, and 30 (71.4%) had CC genotype. There was no statistically significant difference between AC and CC genotypes in predicting clinically significant anaemia (45.5% 63.3%, =0.302). Even among patients who developed anaemia, 70.8% still managed to achieve SVR. Treatment reduction also had no impact on SVR. Hepatitis C genotype 1 patients should be informed of the response rate for treatment with PEG-IFN and ribavirin in a population with favourable IL28B genotype before consideration of newer therapeutic options.
使用聚乙二醇干扰素（PEG-IFN）和利巴韦林的传统丙型肝炎治疗方法会产生明显的副作用。基因多态性可预测治疗反应，CC基因型反应更佳。基因缺陷可预防治疗引起的具有临床意义的贫血。本研究的目的是确定接受过PEG-IFN和利巴韦林治疗的丙型肝炎1型患者中的基因多态性和基因变异及其与持续病毒学应答（SVR）的关联。通过现有病历识别过去10年中接受过PEG-IFN和利巴韦林治疗的所有丙型肝炎1型患者，并通过邀请函联系他们参加研究。采集血液样本进行基因分型。查阅病历以核实治疗反应、贫血的发生情况以及治疗期间是否需要减少治疗剂量。共有61例丙型肝炎1型患者接受了PEG-IFN和利巴韦林治疗，其中42例同意参加研究。治疗时的平均年龄为45.6±12.9岁，83.3%的患者为男性。33例（78.6%）具有CC基因型，其中25例（75.8%）获得SVR，而9例非C/C基因型患者中只有3例（33.3%）获得SVR（P=0.041）。11例（26.1%）患者具有AC基因型，30例（71.4%）具有CC基因型。在预测具有临床意义的贫血方面，AC和CC基因型之间无统计学显著差异（45.5%对63.3%；P=0.302）。即使在发生贫血的患者中，70.8%的患者仍设法实现了SVR。减少治疗剂量对SVR也没有影响。在考虑更新治疗方案之前，应告知丙型肝炎1型患者在具有有利IL28B基因型人群中使用PEG-IFN和利巴韦林治疗的应答率。
