Ampurdanés S, Olmedo E, Maluenda M D, Forns X, López-Labrador F X, Costa J, Sánchez-Tapias J M, de Anta M T, Rodés J
Liver Unit, Hospital Clinic, Barcelona, Spain.
J Hepatol. 1996 Dec;25(6):827-32. doi: 10.1016/s0168-8278(96)80285-6.
BACKGROUND/AIMS: Prediction of response to interferon therapy is important in the management of chronic hepatitis C. Pre-therapy data are valuable but they may be inaccurate in some cases. Our aim was to investigate whether the biochemical and virological events that occur early during interferon therapy in chronic hepatitis C may predict the final result of the treatment.
ALT and serum HCV-RNA were serially measured in 53 HCV-RNA-positive patients who received a standard 6-month course of interferon therapy. Eleven patients with a sustained response, 23 who responded but subsequently relapsed and 19 who did not respond were studied. HCV-RNA was measured with a commercial kit (Amplicor HCV).
After 4 weeks of treatment, HCV-RNA became negative in 73% of sustained responders, in 26% of transient responders (p = 0.02) and in none of the non-responders. Corresponding figures after 8 weeks of therapy were 82% in sustained responders, 61% in transient responders and 9% in non-responders. The difference between sustained and transient responders at this time was not significant. After 4 weeks of therapy, 82% of sustained responders, 52% of transient responders and none of the non-responders presented normalization of alanine transferase. The difference between sustained and transient responders was not significant. Corresponding figures for normalization of alanine transferase at 8 weeks were 82%, 96% and 0% respectively. At the end of treatment, all sustained responders, 70% of transient responders and none of the non-responders had cleared HCV-RNA from serum.
A rapid normalization of alanine transferase induced by interferon therapy is associated with response, but does not differentiate between transient and permanent response. In contrast, clearance of HCV-RNA after 4 weeks of treatment, but not after 8 weeks, is significatively associated with sustained response. Testing for HCV-RNA early during interferon administration may be valuable for further decisions concerning therapy in patients with chronic hepatitis C.
背景/目的：预测干扰素治疗的反应对于慢性丙型肝炎的管理很重要。治疗前的数据很有价值，但在某些情况下可能不准确。我们的目的是研究慢性丙型肝炎患者干扰素治疗早期发生的生化和病毒学事件是否可以预测治疗的最终结果。
对53例接受标准6个月疗程干扰素治疗的HCV-RNA阳性患者连续测量谷丙转氨酶（ALT）和血清HCV-RNA。研究了11例获得持续应答的患者、23例有反应但随后复发的患者和19例无反应的患者。使用商用试剂盒（Amplicor HCV）测量HCV-RNA。
治疗4周后，73%的持续应答者、26%的短暂应答者（p = 0.02）的HCV-RNA转为阴性，无反应者均未转阴。治疗8周后的相应数字分别为：持续应答者82%，短暂应答者61%，无反应者9%。此时持续应答者和短暂应答者之间的差异不显著。治疗4周后，82%的持续应答者、52%的短暂应答者的谷丙转氨酶恢复正常，无反应者均未恢复正常。持续应答者和短暂应答者之间的差异不显著。8周时谷丙转氨酶恢复正常的相应数字分别为82%、96%和0%。治疗结束时，所有持续应答者、70%的短暂应答者血清中的HCV-RNA已清除，无反应者均未清除。
干扰素治疗诱导的谷丙转氨酶快速恢复正常与治疗反应相关，但不能区分短暂反应和持久反应。相比之下，治疗4周后而非8周后HCV-RNA的清除与持续应答显著相关。在干扰素治疗早期检测HCV-RNA对于慢性丙型肝炎患者进一步的治疗决策可能有价值。
