在西西里岛（意大利南部），丙型肝炎病毒血症作为干扰素治疗反应的预测指标比基因型更为重要。

HCV viraemia is more important than genotype as a predictor of response to interferon in Sicily (southern Italy).

作者信息

Magrin S, Craxi A, Fabiano C, Marino L, Fiorentino G, Lo Iacono O, Volpes R, Di Marco V, Almasio P, Vaccaro A, Urdea M S, Wilber J C, Bonura C, Gianguzza F, Capursi V, Filiberti S, Stuyver L, Pagliaro L

机构信息

Istituto di Medicina Generale e Pneumologia, University of Palermo, Italy.

出版信息

J Hepatol. 1996 Nov;25(5):583-90. doi: 10.1016/s0168-8278(96)80224-8.

DOI:10.1016/s0168-8278(96)80224-8

PMID:8938531

Abstract

BACKGROUND/AIMS: To investigate host- and virus-related factors predictive of early and sustained alanine aminotransferase normalization after interferon therapy for HCV-related chronic liver disease, in an area where genotype 1 is highly prevalent.

METHODS

We studied 100 patients with HCV-RNA positive chronic liver disease (73 chronic hepatitis and 27 cirrhosis) undergoing alpha-interferon treatment. Thirty-four patients had an early response but relapsed, 15 patients remained into sustained response for at least 12 months after therapy, and 51 patients did not respond. Serum HCV-RNA levels were assessed by bDNA (Chiron), and genotype by LiPA (Innogenetics) and by sequencing of the 5' non-coding region.

RESULTS

Mean pre-treatment HCV-RNA level (x 10(3) genome equivalents/ml +/- SD) was lower in sustained responders (3854 +/- 7142) than in relapsers (9587 +/- 10163) or in non-responders (5709 +/- 6618). HCV subtype 1b was highly prevalent (82%), while types 1a, 2a, 3 and 4 were rare (about 5% each). However, the prevalence of 1b was much lower (31%) under 40 years of age. The prevalence of subtype 1b among sustained responders (74%) was similar to that observed among relapsers (82%) or non-responders (84%), but some nucleotide substitutions in the putative RNA loop of the 5' non-coding region were seen only among relapsers or non-responders. Multiple logistic regression model showed that early response to interferon was predicted by absence of cirrhosis and a pre-treatment HCV-RNA level below 350. Sustained response to interferon was predicted by pre-treatment HCV-RNA level below 350 and a low fibrosis score.

CONCLUSIONS

Among patients with hepatitis C from an area where subtype 1b is highly prevalent, absence of cirrhosis and low pre-treatment serum HCV-RNA level are the most important predictors of response to IFN. Some nucleotide substitutions found in the 5' non-coding region of subtype 1b are associated with non-response or relapse.

摘要

背景/目的：在1型基因型高度流行的地区，研究丙型肝炎病毒（HCV）相关慢性肝病患者接受干扰素治疗后，预测丙氨酸氨基转移酶早期和持续恢复正常的宿主及病毒相关因素。

方法

我们研究了100例HCV-RNA阳性慢性肝病患者（73例慢性肝炎和27例肝硬化）接受α干扰素治疗的情况。34例患者有早期应答但复发，15例患者治疗后持续应答至少12个月，51例患者无应答。血清HCV-RNA水平采用分支DNA法（Chiron公司）评估，基因型采用线性探针分析（LiPA，Innogenetics公司）及5'非编码区测序法检测。

结果

持续应答者治疗前平均HCV-RNA水平（×10³基因组当量/ml±标准差）（3854±7142）低于复发者（9587±10163）或无应答者（5709±6618）。HCV 1b亚型高度流行（82%），而1a、2a、3和4型少见（各约5%）。然而，40岁以下人群中1b型的流行率低得多（31%）。持续应答者中1b亚型的流行率（74%）与复发者（82%）或无应答者（84%）相似，但仅在复发者或无应答者中观察到5'非编码区假定RNA环中的一些核苷酸替换。多因素logistic回归模型显示，无肝硬化及治疗前HCV-RNA水平低于350可预测对干扰素的早期应答。治疗前HCV-RNA水平低于350及低纤维化评分可预测对干扰素的持续应答。