慢性丙型肝炎血脂变化与抗病毒疗效的关系  

Relationship between efficacy of antiviral treatment and changes in blood lipid metabolism in patients with chronic hepatitis C

作　　者：李磊[1] 罗明[1] 杨二娜[2] 王瑞[3] 王会清[3] 曹武奎[3] 

机构地区：[1]天津医科大学研究生院,天津市300070 [2]天津中医药大学研究生院,天津市300070 [3]天津市传染病医院,天津市300070

出　　处：《世界华人消化杂志》2012年第30期2961-2965,共5页World Chinese Journal of Digestology

摘　　要：目的:分析比较慢性丙型病毒性肝炎(chronic hepatitis C,HCV)抗病毒治疗前、后血脂变化与治疗疗效的关系,为评估预后、及时调整治疗方案提供依据.方法:选择74例慢性HCV,给予聚乙二醇干扰素a-2a联合利巴韦林抗病毒治疗,对其治疗前、治疗12、24、48wk的HCV-RNA定量和甘油三酯(triglycerides,TG)、总胆固醇(total cholesterol,TC)、高密度脂蛋白胆固醇(low-density lipoprotein cholesterol,HDL-C)、低密度脂蛋白胆固醇(high-density lipoprotein cholesterol,LDL-C)的检测数据进行比较分析.结果:74例患者中获得持续病毒学应答(sustai-nedvirological response,SVR)者43例(58%),非持续病毒学应答(nonsustained virological response,Non-SVR)组31例(42%).治疗前SVR组TG、TC、HDL-C、均低于Non-SVR组,LDL-C高于Non-SVR组,但差异均无显著性.治疗期间两组的TG、TC、HDL-C、LDL-C的变化趋势各有不同,两组TG升高趋势基本相同;SVR组比Non-SVR组治疗前有较低的HDL-C水平,治疗期间降低的程度明显增加,但差异无显著性;治疗初期两组患者LDL-C降低趋势基本相同,治疗至12wk后Non-SVR组患者LDL-C出现回升,HCV-RNA检测值仍在检测线以上,而SVR组LDL-C持续低水平直至治疗结束,并伴有HCV-RNA阴转;SVR组TC在治疗12、24、48wk均处于低下水平,与Non-SVR组相应指标比较,差异均有显著性(P=0.01,0.01,0.03).结论:慢性丙型肝炎抗病毒治疗疗效与机体血脂水平密切相关,但相关程度不尽相同,LDL-C在抗病毒治疗前处低水平,治疗期间出现回升,预示着HCV清除效果不佳.TC在抗病毒治疗前、后持续低水平,是获得SVR的明确信号.AIM： To observe changes in blood lipid metabolism in patients with chronic hepatitis C （CHC） who have received antiretroviral treatment, and to investigate the relationship between efficacy of antiviral treatment and changes in blood lipid metabolism.METHODS： Seventy-four patients with CHC who have received pegylated interferon a-2a and ribavirin for 48 wk were followed. HCV- RNA quantification and serum levels of triglycerides （TG）, total cholesterol （TC）, low-density lipoprotein cholesterol （LDL-C）, and highdensity lipoprotein cholesterol （HDL-C） at 0, 12, 24, and 48 wk were detected and analyzed.RESULTS： Sustained virological response （SVR）was found in 43 （58%） patients with CHC, and 31 （42%） patients had non-sustained virological response （Non-SVR）. Although the SVR group had lower serum levels of TG, TC, HDL-C and higher serum levels of LDL-C before antiviral treatment, there were no significant differences in these parameters between the two groups. The changes in serum levels of different param- eters showed different trends during the treat- ment. TG levels showed an increasing trend in both groups. Serum levels of HDL-C decreased more visibly in the SVR group than in the non- SVR group, but there was no significant difference between them. The decreasing trend of LDL-C levels was the same between the two groups at the early stage of treatment; however, serum levels of LDL-C gradually increased after 12 wk in the non-SVR group, although serum levels of LDL-C at 48 wk were still lower than baseline level, and HCV-RNA was still detect- able. Serum LDL-C was maintained at low levels in the SVR group until the end of treatment, although HCV-RNA was undetectable at this time. After 12 weeks of treatment, serum levels of TC significantly decreased in the SVR group compared to those in the non-SVR group.CONCLUSION： Efficacy of antiviral treatment is closely associated with changes in blood lipid metabolism in patients with CHC. Our finding that serum levels of LDL-C we

关 键 词：慢性丙型肝炎 聚乙二醇干扰素-2 利巴韦林 血脂 

分 类 号：R512.63[医药卫生—内科学]