丙型病毒性肝炎肝硬化患者抗病毒疗效及影响因素分析  

Analysis of antiviral effect and the influence factors in hepatitis C patients with cirrhosis

作　　者：李媛[1] 王久君[1] 刘倩[1] 高珊[1] 白佳[1] 郝友华[1] 丁红晖[1] 赵西平[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院感染科,武汉430030

出　　处：《临床内科杂志》2013年第4期233-236,共4页Journal of Clinical Internal Medicine

基　　金：“十一五”科技重大专项（2008ZXl0002-009、2008ZXl0002-014）;“十二五”科技重大专项（2012ZX10002007J003）;国家重点基础研究发展计划（2009CB522502）

摘　　要：目的研究丙型病毒性肝炎肝硬化患者抗病毒治疗耐受及应答情况，探讨丙型肝炎抗病毒疗效的影响因素。方法收集慢性丙型肝炎患者52例，其中肝硬化患者13例，非肝硬化患者39例，均给予干扰素（IFN）联合利巴韦林抗病毒治疗后，观察两组患者病毒学应答、生化学应答及不良反应发生情况。结果，丙型肝炎肝硬化组平均年龄为（58．31±8．72）岁，非肝硬化组平均年龄为（36．95±15．30），两组比较差异无统计学意义（P〉0．05）。肝硬化患者快速病毒学应答率（RVR）、早期病毒学应答率（EVR）和持续病毒学应答率（SVR）分别为84．62％、100．00％和53．85％，非肝硬化患者RVR、EVR和SVR分别为92．31％、100．00％和71．79％，两组比较差异均无统计学意义（P〉0．05）。两组生化学应答比较差异均无统计学意义（P〉0．05）。肝硬化组患者中性粒细胞减少、血小板减少和贫血的发生率均明显高于非肝硬化组，两组比较差异均有统计学意义（P〈0．05）。肝硬化组患者中有2例出现白蛋白下降和腹水，其中1例中断治疗。老年（年龄≥60岁）和采用普通IFN联合利巴韦林抗病毒治疗的患者获得SVR率明显低于中青年患者（年龄〈60岁）和采用长效IFN联合利巴韦林抗病毒治疗的患者（P〈0．05）。基因1型患者的SVR率低于非基因1型，但差异无统计学意义（P〉0．05）。结论代偿期丙型病毒性肝炎肝硬化患者多能耐受抗病毒治疗，且远期疗效较好。Objective To investigate the antiviral treatment tolerance and response condition in hepatitis C patients with cirrhosis, and discuss the influence factors of antiviral outcome in hepatitis C. Methods 52 cases of chronic hepatitis C patients were divided into cirrhotic patients （n = 13） and non- cirrhotic patients（ n = 39）. After interferon plus ribavirin combination antiviral therapy,observed virologi- cal response, biochemical response and adverse effects incidence in the two groups. Results The ages of cirrhotic patients （58.31 ± 8.72） were older than the non-cirrhotic patients （36.95± 15.30）, but the difference of two groups had no statistics significance （ P 〉 0.05 ）. The rates of rapid virological response （RVR）, early virological response （EVR） and sustained virological response （SVR） were 84.62%, 100% and 53.85% respectively in cirrhotic patients. The rates of RVR,EVR and SVR were 92.31%, 100% and 71.79% respectively in non-cirrhotic patients. There were no significant differences between the two groups（P〉 0.05）. There were no significant differences in biochemical response between the two groups （ P 〉 0.05 ）. Compared with the non-cirrhotic patients, the incidence of neutrepenia, thrembocytope- nia and anemia increased in cirrhotic patients, and there were significant differences between the two groups（P 〈0.05）. 2 cases of cirrhotic patients appeared albumin decline and ascites,including 1 case to discontinue treatment. The younger age of patients （ ages 〈 60 years old） and the use of peg-interferon in treatment regime favoured the SVR of patients （ P 〈 0.05 ）. The SVR of genotype 1 patients was lower than non genotype 1 patients, but this difference was not statistically significant （P 〉 0.05）. Conclusion Pa- tients with chronic hepatitis C and compensated cirrhosis could be able to withstand the standard antiviral therapy,with high incidence of SVR.

关 键 词：慢性丙型肝炎 肝硬化 抗病毒治疗 

分 类 号：R512.63[医药卫生—内科学]