聚乙二醇干扰素α-2a联合利巴韦林治疗自身免疫抗体阳性慢性丙型肝炎的临床疗效  

Efficacy of combination therapy with pegylated-interferon alfa-2a plus ribavirin in autoantibody-positivechronic hepatitis C patients

作　　者：李雅馨[1] 杨彦佳[1] 杨梅[1] 陈立宇 卢家桀[1] 马元吉[1] 刘凯[1] 雷学忠[1] 唐红[1] 

机构地区：[1]四川大学华西医院感染性疾病中心,成都610041

出　　处：《中华肝脏病杂志》2013年第5期345-347,共3页Chinese Journal of Hepatology

基　　金：四川大学青年科研基金（06063）

摘　　要：目的观察聚乙二醇干扰素α-2a（Peg-IFNα-2a）联合利巴韦林（RBV）治疗自身免疫抗体阳性慢性丙型肝炎患者的疗效，并与自身免疫抗体阴性的患者比较，探讨自身免疫抗体是否影响慢性丙型肝炎疗效。方法86例慢性丙型肝炎患者完善自身免疫抗体等检测后，按体质量给予Peg-IFNα-2a135μg或180μg，每周1次，皮下注射；联合按体质量分配的利巴韦林800～1200mg／d，分次口服，共治疗48周。分别检测治疗前，治疗后4、12、24、36、48周以及治疗终止后24周的HCVRNA载量。数据比较用单因素方差分析或X2检验。结果24例患者检出至少1种自身免疫抗体，其中抗线粒体抗体（ANA）阳性14例，抗平滑肌抗体阳性5例，抗1型肝肾微粒抗体阳性3例，ANA合并抗SSB抗体阳性1例，ANA合并抗肝细胞胞浆抗原1型抗体阳性1例。24例自身免疫抗体阳性患者中，17例（70．8％）获得了快速病毒学应答（RVR），19例（79．2％）获得了持续病毒学应答（SVR）；62例自身免疫抗体阴性的患者中，45例（72．5％）获得了RVR，51例（82．20／0）获得了SVR，两组患者的RVR及SVR率差异均无统计学意义（X2值分别为0．026和0．001，P值均〉0．05）。结论Peg-IFNα-2a联合RBV治疗自身免疫抗体阳性的慢性丙型肝炎患者仍然有显著疗效；自身免疫抗体的检出可能不是慢性丙型肝炎患者疗效的独立预测因素。Objective To evaluate the therapeutic efficacy of antiviral combination therapy with pegylated-interferon alfa-2a（Peg-IFNa-2a） plus ribavirin （RBV） in patients with autoantibody-positive chronic hepatitis C （CHC） and to investigate the impact of the presence of autoantibodies on the treatment outcome. Methods Eighty-six consecutive CHC patients who underwent a 48-week treatment regimen composed of Peg-IFNa-2a （135 or 180 μg/wk） plus weight-based RBV （ ≤ 65 kg, 800 mg/d; 65-75 kg, 1000 mg/d; ≥ 75 kg, 1200 μg/d）. Prior to treatment （baseline） and at end of treatment （EOT; week 48）, levels of antinuclear antibody （ANA）, anti-smooth muscle antibody （SMA）, anti-liver/kidney microsomal antibody type 1 （LKM1）, anti-La （SSB）, and anti-liver cytosolic-1 （LC-1） were detected by indirect At baseline, during treatment （weeks 4, 12, 24, and 36）, EOT, and 24 weeks after EOT, levels ofHCV RNA were assessed by real-time quantitative PCR. Rapid virological response （RVR） was defined as HCV RNA 〈 103 copy/ml at week 4. Sustained virologic response （SVR） was defined as HCV RNA load below the lower limit of detectionat 24 weeks aRcr EOT. Correlation between autoantibodies and treatment-induced reduced HCV RNA load was assessed by univariate analysis of variance or chi-squared tests. Results Autoantibodies were detected in 24 patients, which included 14 ANA-positive patients, five SMA-positive patients, three LKMl-positive patients, one patient with double-positivity for ANA and SSB, and one patient with double-positivity for ANA and LC=I. The autoantibody-positive patients and autoantibody-negative patients showed similar rates of RVR （70.8% vs. 72.5%, P 〉 0.05） and SVR （81.4% vs. 82.2%, P 〉 0.05）. Conclusion Antiviral therapy with Peg-IFNa-2a ＋ RBV can effectively reduce the HCV RNA load in autoantibody-positive CHC patients; however, the presence of autoantibodies may not be an ind^endent predictor of therapy outcome.

关 键 词：肝炎 丙型 慢性 自身抗体 干扰素Α-2A 利巴韦林 

分 类 号：R512.63[医药卫生—内科学]