Hopf U, Berg T, König V, Küther S, Heuft H G, Lobeck H
Department of Internal Medicine, Virchow-Klinikum, Humboldt Universität Berlin, Germany.
J Hepatol. 1996;24(2 Suppl):67-73.
To evaluate the importance of hepatitis C virus (HCV) genotypes for the long-term response to interferon alpha (IFN alpha) therapy, we retrospectively investigated 81 patients with chronic hepatitis C treated within two randomized multicenter studies with comparable inclusion criteria. Forty patients received recombinant IFN alpha 3 MU three times a week for 12 months and 41 patients lymphoblastoid IFN alpha 3 or 5 MU three times a week for 6 or 12 months (total dosage 216-720 MU). The patients were followed up for up to 4 yr (2-4 yr, mean 3.2 yr). A sustained remission defined as normalization of aminotransferases and negative PCR for HCV-RNA was achieved in 23% of patients treated with recombinant IFN alpha and in 25% of the group with lymphoblastoid IFN alpha therapy. All patients with sustained remission showed a normalization of aminotransferases during the first 3 months of therapy. Determination of HCV genotypes revealed a major prevalence of type 1 (77%) versus type 2 (5%) and type 3 (18%). The response rate was significantly higher in patients with type 2 and 3 infections (75 and 73%) than in patients infected with genotype 1 (37%) (p = 0.005). Sustained remission was observed in 13% for genotype 1, in 75% for genotype 2, and in 33% for genotype 3 (differences between type 2/3 versus type 1, p = 0.03). There were no significant differences between responders and non-responders concerning age, level of aminotransferases before therapy or the dosage and type of IFN alpha administered. The data indicate that the determination of HCV genotypes may have prognostic relevance in the responsiveness to IFN alpha therapy.
为评估丙型肝炎病毒（HCV）基因型对干扰素α（IFNα）治疗长期疗效的重要性，我们回顾性研究了81例慢性丙型肝炎患者，这些患者来自两项纳入标准可比的随机多中心研究。40例患者接受重组IFNα 3MU，每周3次，共12个月；41例患者接受淋巴母细胞IFNα 3或5MU，每周3次，共6或12个月（总剂量216 - 720MU）。对患者进行了长达4年（2 - 4年，平均3.2年）的随访。用重组IFNα治疗的患者中23%实现了持续缓解，定义为转氨酶正常且HCV - RNA的PCR检测为阴性；接受淋巴母细胞IFNα治疗的患者组中这一比例为25%。所有实现持续缓解的患者在治疗的前3个月转氨酶均恢复正常。HCV基因型测定显示，1型占主要比例（77%），2型（5%）和3型（18%）。2型和3型感染患者的缓解率（分别为75%和73%）显著高于1型感染患者（37%）（p = 0.005）。1型基因型患者的持续缓解率为13%，2型为75%，3型为33%（2/3型与1型之间的差异，p = 0.03）。在年龄、治疗前转氨酶水平或所给予的IFNα剂量和类型方面，缓解者与未缓解者之间无显著差异。数据表明，HCV基因型的测定可能对IFNα治疗的反应性具有预后意义。
