干扰素治疗慢性丙型肝炎的持续应答与复发相关因素的研究  

The factors associated with viral relapse after interferon treatment in chronic hepatitis C patients

作　　者：马烈[1] 赵辉[1] 谢尧[1] 李明慧[1] 徐道振[1] 陆志檬[2] 骆抗先[3] 贾继东[4] 王宇明[5] 赵桂珍[6] 张树林[7] 张大志[8] 

机构地区：[1]北京地坛医院,100011 [2]上海瑞金医院 [3]南方医科大学南方医院 [4]北京友谊医院 [5]第三军医大学西南医院 [6]中国医科大学第二附属医院 [7]西安交通大学第一附属医院 [8]重庆医科大学附属第二医院

出　　处：《中华肝脏病杂志》2006年第8期565-568,共4页Chinese Journal of Hepatology

摘　　要：目的探讨丙型肝炎病毒(HCV)基因型、RNA含量与肝组织炎症活动的相关性,慢性丙型肝炎患者经干扰素治疗后复发的相关因素。方法对慢性丙型肝炎患者的血清进行丙氨酸氨基转移酶(ALT)检测,采用Cobas Amplicor Monnitour Test.version 2.0试剂进行HCV RNA定量和Simmonds酶切分型方法进行HCV基因分型检测。对聚乙二醇化干扰素α-2a(PEG-IFNα-2a)与干扰素α-2a治疗24周结束时,取得病毒学应答的慢性丙型肝炎患者进行24周随访观察,对临床特征、病毒学特征、治疗药物等因素与复发的相关性进行分析。结果208例丙型肝炎患者基础HCV RNA含量与ALT水平无相关h生(r=0.093,P＞0.05),HCV基因1型与非基因1型之间ALT的水平差异无统计学意义,HCV基因型与RNA含量无相关性；在治疗结束取得病毒学应答的119例患者中,随访24周持续应答者61例(51.3％),复发58例(48.7％)。患者的性别、年龄、HCV感染途径、既往干扰素治疗史、天冬氨酸氨基转移酶／ALT比值、血小板计数和血清基础HCV载量等因素均与复发率无显著相关性。基因1型患者复发率(54.5％)显著高于非1型(32.1％)(x^2=4.265,P=0.039)。PEG-IFNα-2a组复发率(47.0％)低于IFNα-2a组(52.8％),但差异无统计学意义。结论病毒基因型与慢性丙型肝炎干扰素治疗后的病毒复发显著相关。Objective To investigate the relationship between hepatitis C virus （HCV） genotype, serum viral load and ALT levels, and the factors associated with the viral relapse after IFN treatment in patients with chronic hepatitis C. Methods The HCV RNA levels were determined with Cobas Amplicor Monitor Test, version 2.0, and HCV genotypes were examined by means of PCR products of 5＇ NTR digested with restriction endonucleases. The patients with chronic hepatitis C were treated with PEG-IFN α-2a and Roferon-A for 24 weeks. Those with a viral response after 24 week treatment were followed for an additional 24 weeks. The association of clinical characteristics, such as sex, age, the way of the HCV infection, IFN treatment history and platelet counts, and the HCV genotype, virus load and medicine used for the viral relapse after IFN treatment were analyzed. Results Of the 208 chronic hepatitis C patients, the ALT levels were not related to HCV RNA levels （r = 0.093, P 〉 0.05）. No difference of ALT levels between HCV genotypes was found, and the HCV RNA load was also of no difference between HCV genotype 1 patients and non 1 patients. Of the 119 patients with viral response after 24 week treatment, 58 cases （48.7%） relapsed after another 24 week＇s follow-up. Relapse was not significantly related to the clinical characteristics, such as sex, age, mode of the infection, treatment history of IFN, AST/ALT ratio, platelet counts and the baseline viral load. Among patients with genotype 1 virus, the relapse rate was significantly higher than those patients with non-genotype 1 virus （54.5% vs 32.1%, P = 0.039）. The relapse rate after PEG-IFN α-2a treatment was lower than that of Roferon-A treatment （47.0% vs 52.8%）, but not significantly. Conclusion The viral relapse of chronic hepatitis C patients after IFN treatment was significantly associated with the genotypes of the HCV.

关 键 词：肝炎 丙型 慢性 治疗 干扰素Α 基因型 干扰素 聚乙二醇化 

分 类 号：R512.63[医药卫生—内科学]