老年慢性丙型肝炎患者抗病毒疗效及影响因素探讨  

Exploration of antiviral efficacy and the influencing factors in elderly patients with chronic hepatitis C

作　　者：陈学福[1,2] 陈小苹[1,2] 马晓军[1,2] 陈文莉[1,2] 陈仁[1,2] 廖金瑶 

机构地区：[1]广东省人民医院感染科 [2]广东省医学科学院,广州510080

出　　处：《肝脏》2014年第10期722-724,共3页Chinese Hepatology

摘　　要：目的探讨老年慢性丙型肝炎患者抗病毒疗效及影响因素。方法回顾性分析42例老年慢性丙型肝炎患者经聚乙二醇干扰素(Peg-IFNα-2a)联合利巴韦林治疗48周随访24周的病毒学应答、复发及无应答情况,分析与病毒学应答相关的影响因素。结果 42例老年慢性丙型肝炎患者获得快速病毒学应答(RVR)、早期病毒学应答(EVR)、持续病毒学应答(SVR)比例分别为42.9%、78.6%、57.1%,复发率为26.2%,无应答率为21.4%。RVR组、EVR组的SVR为77.8%、72.7%,均高于非RVR组、非EVR组的41.7%、0(P值分别为0.02、0.00)。SVR组的病程(10.0±4.6)年、基线HCV RNA(5.67±0.82)lg拷贝/mL、基因Ⅰ型占45.8%,显著低于非SVR组的(17.2±5.6)年、(6.39±0.92)lg拷贝/mL和83.3%(P值分别为0.00、0.02、0.01);IL-28B基因多态性CC等位基因为83.3%,明显高于非SVR组的50%(P=0.02)。81%的老年慢性丙型肝炎患者感染途径是有手术史或输血史,78.6%的患者病程>10年。结论老年慢性丙型肝炎患者可获得较高的病毒学应答率。感染HCV年限、基线HCV RNA载量、非基因Ⅰ型以及IL-28B等位基因CC型和RVR、EVR是预测抗病毒疗效的影响因素。Objective To explore antiviral efficacy and the influencing factors in elderly patients with chronic hepatitis C. Methods Clinical data for 42 elderly patients with chronic hepatitis C were analyzed retrospectively. Influencing factors of virological response were evaluated. Results Forty-two elderly patients with chronic hepatitis C, who received peginterferon （Peg-interferonsα-2 a）plus ribavirin treatment for 48 weeks,were followed-up for 24 weeks. Proportions of rapid virological response （RVR ）,early virological response （EVR ）,sustained virological response （SVR）were 42.9% ,42.9% and 57.1% ,respectively. Relapse rate was 26.2% ,and non-response rate was 21 .4% . SVR in RVR or EVR group（77.8% ,72.7% ）was higher than that in non-RVR or non-EVR group（41 .7% ,0% ）（P=0.02,0.00）. Compared with non-SVR group,SVR group had significantly shorter disease course （10.0±4.62 years vs. 17.2±5.63 years,P= 0.00）,lower HCV RNA level at baseline （5.67±0.82 log10 copies/ml vs. 6.39±0.92 log10 copies/ml,P= 0.00）and less genotype I patients （45.8% vs. 83.3% ,P= 0.01 ）. IL-28B gene polymorphism CC （83.3% ）was significantly higher in SVR group than that in non-SVR group （50% ）（P= 0.02）. Eighty-one percent of the elderly patients with chronic hepatitis C had histories of surgery or blood transfusion,and 78 .6% of those patients′disease courses were more than ten years. Conclusion Elderly patients with chronic hepatitis C can obtain higher virological response rates. Disease course of hepatitis C, HCV RNA loads at baseline, genotype, IL-28B gene polymorphism CC,RVR and EVR are influencing factors which could predict the efficacy of antiviral therapy. Elderly patients with chronic hepatitis C should be paid more attention to early screening,early diagnosis and early treatment.

关 键 词：慢性丙型肝炎 老年人 病毒学应答 

分 类 号：R512.63[医药卫生—内科学]