聚乙二醇干扰素联合利巴韦林治疗慢性丙型肝炎初治与再治患者的回顾性研究  

Effects of pegylated interferon plus ribavirin on naive and retreat chronic hepatitis C patients： a retrospective study

作　　者：杨宗国[1] 叶佩燕[1] 陈晓蓉[1] 刘成[1] 

机构地区：[1]上海市公共卫生临床中心中医科,201508

出　　处：《中华全科医师杂志》2012年第11期836-839,共4页Chinese Journal of General Practitioners

基　　金：国家科技重大专项（2008ZX10502）;上海市科委引导类项目（10411963000）

摘　　要：目的评价聚乙二醇干扰素联合利巴韦林对慢性丙型肝炎初治与再治患者的疗效。方法2008年1月至2012年2月回顾性分析上海市公共卫生临床中心慢性丙型肝炎病例67例，以是否为初治将患者分为初治组与再治组，初治组35例，再治组32例，分析两组患者病毒学应答之间的差异及影响因素。结果①初治组患者获得快速病毒学应答（RVR）、早期病毒学应答（EVR）比率明显高于再治组[60％（21例）比28％（9例），77％（27例）比53％（17例）；均P〈0．05]，但两组治疗结束时病毒学应答（ETR）、持续病毒学应答（SVR）的比率差异无统计学意义[86％（30例）比72％（23例），77％（27例）比56％（18例）；均P〉0．05]；②再治组慢性丙型肝炎患者治疗结束后复发率高于初治组[22％（5例）比10％（3例）]，但差异无统计学意义（P〉0．05）；③既往有干扰素抗病毒治疗史的患者再次以聚乙二醇干扰素联合利巴韦林治疗后获得RVR、EVR、ETR、SVR的差异无统计学意义（均P〉0．05）；④再治者SVR低于初治者[56％（18例）比77％（27例）]，基因1型SVR低于非l型[54％（13例）比74％（32例）]，经多因素分析，OR值分别为0．29，0．26（均P〈0．05）。结论慢性丙型肝炎初治患者较再治患者获得较高病毒学应答率，复发率较低；既往治疗方案采用普通干扰素或聚乙二醇干扰素对再治慢性丙型肝炎患者获得病毒学应答无影响；再治与基因1型是慢性丙型肝炎患者获得SVR的危险因素。Objective To evaluate the effects of pegylated interferon plus ribavirin on naive and retreated chronic hepatitis C （CHC） patients. Methods A total of 67 CHC patients were divided into naive group （ n = 35 ） and retreat group （ n = 32） based on their treatment history. And their virological responses [ rapid virological response （RVR） , early virological response （EVR） , virological response to etravirine （ETR） and sustained virological response （SVR）] and risk factors were analyzed. Results ①RVR and EVR of naive group were 60% （ n = 21 ） and 77% （ n = 27）, respectively, and the retreat group were 28% （n =9） , 53% （n = 17）. The differences between the two groups were significant （both P 〈0. 05）. On the contrary, CHC patients in both groups might achieve similar ETR and SVR rates （ P 〉 0. 05 ） ;② The relapse rate in the retreat group was higher than that in the naive group （22% vs. 10% ）. But the differences had no statistical significance （ P 〉 0. 05 ） ; ③ CHC patients in the retreat group could achieve similar responses, including RVR, EVR, ETR and SVR （ P 〉 0. 05 ） whether treated previously with standard interferon or pegylated interferon; ④ According to multivariable logistic regression analysis, the retreated genotype 1 CHC patients has a lower SVR rate compared with naive genotype non-1 counterparts （ OR = 0. 29 and 0. 26, all P 〈 0. 05 ）. Conclusions CHC patients in the naive group could achieve higher virological responses and a lower relapse rate compared to those in the retreat group. The previous treatment regimen has no significant effect on virological responses of CHC patients retreated with Peg-IFN plus ribavirin. Genotype 1 and retreatment are both risk factors of achieving SVR.

关 键 词：肝炎 丙型 慢性 干扰素Α-2A 利巴韦林 

分 类 号：R512.63[医药卫生—内科学]