Trepo C, Habersetzer F, Bailly F, Berby F, Pichoud C, Berthillon P, Vitvitski L
Service d'Hépato-Gastroentérologie, Hôpital Hôtel-Dieu, LYON, France.
Pathol Biol (Paris). 1995 Oct;43(8):716-24.
The treatment of hepatitis C virus (HCV) infections is essentially known for chronic hepatitis C and is mainly restricted to interferon alpha. Initial trials have indicated that around 50% of the patients with chronic hepatitis C respond to alpha interferon (administered at 3 MU, thrice weekly, during 6 months) by normalizing alanine aminotransferase at the end of therapy, although 25% were found to relapse after therapy. Normalization of biochemical tests is associated with an improvement in liver histological features and with decrease or loss of HCV from serum and liver. Response to therapy is influenced by both duration and dose levels of the treatment. Following studies which showed that higher doses and longer duration were more effective than the current recommendations of 3MU thrice weekly for 6 months have recently conducted to the recent recommendation of a 12 month course of therapy using 3 MU. The outcome of therapy was also shown to be negatively influenced by longer duration of disease and presence of cirrhosis. More recently, the critical role of virological markers has been emphasized with a lower rate of response in patients infected with the genotype 1 b and a high viral load. However, these factors do not certainly predict for an individual patient the quality of the response. Therapeutical goals are: to precisely define pre-treatment scores of response able to give each individual patient the optimal treatment regimen, non responders to interferon alpha and patients with a transient benefit of therapy. Thus, development of new treatments appears critical among which those with other interferons and above all the bitherapy using ribavirin and interferon alpha which may have a marked increase in efficacy in comparison with interferon alpha used as monotherapy.
丙型肝炎病毒（HCV）感染的治疗主要针对慢性丙型肝炎，且主要局限于使用α干扰素。初步试验表明，约50%的慢性丙型肝炎患者在治疗结束时丙氨酸转氨酶恢复正常，对α干扰素（每周三次，每次3 MU，持续6个月）有反应，尽管发现25%的患者在治疗后复发。生化检测的正常化与肝脏组织学特征的改善以及血清和肝脏中HCV的减少或清除有关。治疗反应受治疗持续时间和剂量水平的影响。随后的研究表明，更高剂量和更长疗程比目前推荐的每周三次、每次3MU、持续6个月更有效，最近已将治疗疗程推荐为使用3MU进行12个月的治疗。治疗结果还显示受疾病持续时间延长和肝硬化的影响。最近，病毒学标志物的关键作用得到了强调，感染1b基因型且病毒载量高的患者反应率较低。然而，这些因素并不能确切预测个体患者的反应质量。治疗目标是：精确确定能够为每个个体患者提供最佳治疗方案的治疗前反应评分，对α干扰素无反应者以及治疗有短暂益处的患者。因此，开发新的治疗方法显得至关重要，其中包括使用其他干扰素的治疗方法，尤其是使用利巴韦林和α干扰素的联合治疗，与单独使用α干扰素相比，其疗效可能会显著提高。
