慢性丙型肝炎患者抗病毒治疗中肝功能与病毒学应答的关系  

Relationship between liver function and virological response in patients with chronic hepatitis C during antiviral treatment

作　　者：孔文丽 杨以良 徐洪芹 彭姗姗[1] 华瑞[1] 潘煜[1] 牛俊奇[1] 

机构地区：[1]吉林大学第一医院肝胆胰内科,吉林长春130021

出　　处：《吉林大学学报（医学版）》2016年第1期99-103,共5页Journal of Jilin University：Medicine Edition

基　　金：国家自然科学基金资助课题(81072347);国家自然科学基金青年基金资助课题(81200289)

摘　　要：目的:观察干扰素α2b(INF-α2b)联合利巴韦林治疗慢性丙型肝炎(CHC)患者肝功能变化的特点,探讨不同病毒学应答模式与肝功能的关系。方法:选取CHC患者264例,给予INF-α2b500万U,隔日1次皮下注射;利巴韦林15 mg·kg-1,每日1次口服,疗程48周。检测不同时间点(基线,治疗12、24、48和72周)患者HCV RNA定量和肝功能等指标。根据转归情况,将患者分为持续病毒学应答(SVR)组、治疗中反弹组、复发组和无应答组,比较4组患者治疗前后肝功能的变化及与应答的关系。结果:264例患者中171例(64.8%)获得SVR,37例(14.0%)治疗中反弹,47例(17.8%)复发,9例(3.4%)无应答。与治疗中反弹组比较,基线丙氨酸氨基转移酶(ALT)水平轻度升高的患者较ALT正常的患者易获得SVR(P<0.05)。经抗病毒治疗,4组患者血清ALT和天冬氨酸氨基转移酶(AST)均下降,且12周时下降最明显,与治疗前比较差异有统计学意义(P<0.05)。治疗中反弹组患者在48周时ALT和AST回升,复发组患者停药后24周时ALT和AST回升,直至停药后24周SVR组患者的ALT和AST可维持稳定。与治疗中反弹组比较,SVR组患者在12周时ALT和AST下降更明显,与治疗前比较差异有统计学意义(P<0.05)。在抗病毒治疗过程中,无应答组患者血清ALT和AST水平始终高于SVR组、复发组和治疗中反弹组(P<0.05)。与治疗前比较,SVR组患者在12周时总胆红素(TBIL)和直接胆红素(DBIL)水平较其他时间点明显下降(P<0.05),直至停药后24周可以维持稳定。在治疗24周时,无应答组患者血清TBIL、DBIL水平明显高于SVR组和治疗中反弹组患者(P<0.05)。结论:CHC患者基线ALT水平可能与病毒学应答有关。CHC患者抗病毒治疗后肝功能改善,尤其SVR患者改善更明显,随着病毒的复发或反弹,转氨酶会再次升高。Objective： To explore the changes of liver function in the patients with chronic hepatitis C （CHC） received interferon alpha 2b （INF-a2b） combined with ribavirin therapy, and to study the relationship between the different virological response patterns and liver function. Methods： 264 CHC patients were enrolled. All patients received INF-a2b （5 000 000 U, every other day, subcutaneous injection） combined with ribavirin （15 mg ·kg-1 ·d-1 , oral） for 48 weeks. The serum HCV RNA level and liver function were assessed at different time points. According to the outcome, the patients were divided into sustained virological response （SVR）, breakthrough, relapse and no response （NR） groups. The relationship between the liver function changes and response in the patients with CHC in various groups before and after treatment was compared. Results： Amon264 patients, 171 patients （64.8%） achieved SVR, 37 patients （14.0%） were breakthrough, 47 patients （17.8%） were relapse and 9 patients （3.4%） were NR. Compared with breakthrough group, the patients with moderately elevated alanine transaminase （ALT） level in SVR group were easy to achieve SVR than the patients with normal ALT level （P〈0.05）. After antiviral treatment, the serum ALT and aspartate transaminase （AST） levels were decreased in all patients, especialy at the 12th week and there were significant differences compared with before treatment （P〈0.05）. The serum ALT and AST levels of the patients in breakthrough group were increased again at the 48th week. In relapse group, the serum ALT and AST levels of the patients were increased again at the 24th week after drug withdrawal. Untill to the 24th week after drug withdrawal, the serum ALT and AST levels were stable in SVR group. Compared with breakthrough group, the serum ALT and AST levels had the greatest reduction at the 12th week in SVR group （P〈0. 05）. The serum ALT and AST levels of the patients in NR group were always higher than those in SV

关 键 词：肝炎 慢性 丙型 抗病毒治疗 病毒学应答 肝功能 

分 类 号：R512.63[医药卫生—内科学]