聚乙二醇干扰素联合利巴韦林治疗慢性丙型肝炎及其合并人类免疫缺陷病毒感染者的疗效  

Differential response to pegylated interferon plus ribavirin combination therapy in chronic hepatitis C and HIV/HCV co-infected patients

作　　者：刘波[1] 蔡卫平[1] 胡凤玉[1] 许敏[1] 兰芸[1] 唐小平[1] 

机构地区：[1]广州市第八人民医院传染病研究所,510060

出　　处：《中华肝脏病杂志》2013年第11期829-833,共5页Chinese Journal of Hepatology

摘　　要：目的观察人类免疫缺陷病毒（HIV）／丙型肝炎病毒（HCV）合并感染者及HCV单一感染者聚乙二醇干扰素（Peg_INF）联合利巴韦林抗HCV疗效。方法70名HIV／HCv合并感染者（合并感染组）及60例HCV单一感染者（单一感染组），均给予Peg-INFoa-2a联合利巴韦林抗HCV治疗，于治疗0、4、12、24、48周及停药后24周行HCVRNA载量检测。PCR加测序法获得HCV基因型及IL-28B基因rs8099917、rsl2979860及rsl2980275位点基因型。分析两组患者疗效，并分析HCV基因型及IL-28B基因型对疗效的影响。数据采用SPSS16．0软件进行分析。离散型分类计数资料使用x2检验，计量资料使用重复测量数据方差分析、方差分析；独立样本的均数比较采用t检验；对非正态分布数据采用参数检验统计分析。结果持续病毒学应答（SVR）率合并感染组为32．9％，单一感染组为71．7％，两组比较，p=0．000，差异有统计学意义。合并感染组中，HCV-1型和HCV-非1型患者SVR率分别为30．8％和33．3％，P=1．000，差异无统计学意义。单一感染组中，HCV-1型和HCV-非1型患者SVR率分别为86．1％和50．0％，P=0．002，差异有统计学意义。SVR率在HCV-1型单一感染组为86．1％，合并感染组为30．8％，P=0．000，差异有统计学意义。不同IL-28B基因型的疗效，差异无统计学意义。结论单一感染组Peg-INFa-2a联合利巴韦林疗效优于合并感染组；HCV基因1型合并感染组疗效比单一感染组差；IL-28B基因型并不影响Peg-INFa-2a联合利巴韦林疗效。Objective To investigate the potential differences in response to pegylated interferon （Peg-IFN） plus ribavirin （RBV） combination therapy in patients with hepatitis C virus （HCV） mono- infection and human immunodeficiency virus （HIV）/HCV co-infection. Methods Seventy HIV/HCV patients and sixty HCV patients, were administered a 48-week course of Peg-IFN ＋ RBV. The HCV load was tested by the COBAS automatic viral load analysis system （lower limit of quantification = 15 IU/ml） at treatment weeks 0 （baseline）, 4, 12, 24, and 48 and at week 24 after drug withdrawal. The patients were also genotyped by sequencing for the host-encoded interleukin （IL）-28B single nucleotide polymorphisms （SNPs） related to HCV Peg-IFN ＋ RBV therapy outcome： rs8099917, rs12979860 and rs12980275. In addition, the HCV-encoded NS5B gene region was genotyped by nested-PCR and sequencing followed byBLAST searching of the Los Alamos National Laboratory HCV database. The significance of between- group differences in response to therapy and roles of SNPs were evaluated by statistical analyses. Results The ratio of sustained virological response （SVR） was significantly lower in the HIV/HCV co-infected patients than the HCV mono-infected patients （32.9% vs. 71.7%; P 〈 0.001）. While the HIV/I-ICV co-infected patients did not show a significant difference in SVR ratio achieved between individuals infected with the HCV- 1 genotype and the non-HCV-1 genotype （30.8% vs. 33.3%; P = 1.000）, the HCV mono-infected patients did （86.1% vs. non 50.0%, P = 0.002）. Moreover, the SVR ratio was higher in the HCV-1 genotype HCV mono-infected patients than in the HIV/HCV-1 genotype co-infected patents （30.8% vs. 86.1%;P 〈 0.001）. The different IL-28B genotypes were not significantly correlated to the PEG-IFN＋RBV therapy response of either HCV mono-infected patients or HIV/HCV co-infected patients （P 〉 0.05）. Conclusion HCV mono-infected patients respond better to Peg-IFN ＋ RBV therapy than HIV/HC

关 键 词：肝炎 丙型 慢性 人类免疫缺陷病毒 治疗 聚乙二醇干扰素 利巴 韦林 

分 类 号：R512.63[医药卫生—内科学]