血脂水平与慢性丙型肝炎患者抗病毒疗效的相关性分析  

Association between serum lipid levels and antiviral treatment outcome in patients with chronic hepatitis C

作　　者：时佳[1] 沈震[2] 苗慧[1] 杨宗国[1] 徐庆年[1] 陆云飞[1] 吕莹[1] 陈晓蓉[1] 

机构地区：[1]复旦大学附属上海市公共卫生临床中心中医科,上海201508 [2]复旦大学附属上海市公共卫生临床中心检验科,上海201508

出　　处：《临床肝胆病杂志》2014年第6期496-500,共5页Journal of Clinical Hepatology

基　　金：上海市三年行动计划(ZYSNXD-GW-JDJS)

摘　　要：目的分析慢性丙型肝炎(CHC)患者血脂水平与抗病毒疗效的相关性,为评估预后、指导治疗提供依据。方法纳入2010年1月至2013年8月收治的171例CHC初治患者,给予聚乙二醇干扰素(PEG-IFN)及利巴韦林抗病毒治疗,分析比较不同应答情况、基因型及治疗0、12及24周(非1b型)或0、24及48周(1b型)患者血清总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)、载脂蛋白A(apoA)、载脂蛋白B(apoB)水平。正态分布计量资料采用t检验及方差分析;非正态分布资料采用秩和检验;分类变量采用χ2检验。采用单因素及多因素Logistic回归分析筛选与患者预后相关的预测因子。结果171例CHC PEG-IFN及利巴韦林抗病毒初治患者治疗后,获得持续病毒学应答(SVR)率及未获得持续病毒学应答(nonSVR)率分别为81.87%、18.13%,SVR组患者TG、apoB明显较non-SVR组患者低(P<0.05)。基因3型CHC患者TC、LDL-C、apoA及apoB均较基因1b、6a型患者低;ALT、AST水平相比较高(P<0.05)。SVR组患者TG、apoB在治疗结束时升高,HDL-C降低(P<0.05);non-SVR组患者血脂水平在治疗过程中无明显改变。单因素Logistic分析示患者年龄≤50岁、基因型非1b型、TG≤3.11 mmol/L、apoB≤0.63 g/L与SVR密切相关(P<0.05);多因素回归分析表明,年龄≤50岁及apoB≤0.63 g/L CHC患者易获得SVR(P<0.05)。结论本研究提示,血脂水平和年龄与CHC患者抗病毒疗效密切相关,年龄≤50岁和apoB≤0.63 g/L是CHC患者SVR的独立预测因素。Objective To investigate the association between serum lipid levels and antiviral treatment outcome in chronic hepatitis C （CHC）patients.Methods A total of 171 treatment-naive CHC patients were included in the present retrospective study and received a standard therapy of pegylated interferon （PEG-IFN）plus ribavirin.Serum levels of total cholesterol （TC）,triglycerides （TG）,low-den-sity lipoprotein cholesterol （LDL -C）,high -density lipoprotein cholesterol （HDL -C）,apolipoprotein A （apoA）,apolipoprotein B （apoB）,and other vital indicators in laboratory were determined,and their relationships with treatment responses,hepatitis C virus （HCV） genotypes,and therapy time points （for non-1b type,0,12,and 24 weeks;for 1b type,0,24,and 48 weeks）were analyzed.For nor-mally distributed measurement data,values were expressed as mean ±SD,and statistical analysis was performed by t test and ANOVA;for non-normally distributed data,values were expressed as median and interquartile range,and statistical analysis was performed by rank sum test;for categorical variables,values were expressed as frequency （constituent ratio）,and statistical analysis was performed by chi-square test.Univariate and multivariate logistic regression analyses were performed to determine prognostic factors.Results Among the 171 CHC patients receiving PEG-IFN plus ribavirin,81.87%achieved a sustained virological response （SVR）,and 18.13%did not;SVR patients showed significantly lower TG and apoB levels than non-SVR patients （P〈0.05 ）.Compared with patients infected with HCV-1 b and HCV-6a,those with HCV-3 infection had lower serum levels of TC,LDL-C,apoA,and apoB （P〈0.05）,while the opposite results were observed in terms of the levels of alanine aminotransferase and aspartate aminotransferase （P〈0.05）.In the SVR group,significant increases in TG and apoB were observed at the end of treatment process ,while a significant decrease in HDL -C was also noted （P 〈0.05 ）.However,no significa

关 键 词：丙型肝炎 慢性 丙型肝炎病毒 血脂异常 治疗结果 

分 类 号：R512.63[医药卫生—内科学]