聚乙二醇干扰素α-2a联合利巴韦林治疗乙型和丙型肝炎病毒重叠感染的配对分析  

Efficacy of peginterferon α-2a plus ribavirin for the treatment of patients with hepatitis B virus and hepatitis C virus coinfection： a paired study

作　　者：张吉宏[1] 杨宗国[1] 王琳[2] 陈良[3] 

机构地区：[1]山东省即墨市人民医院感染性疾病科,266200 [2]复旦大学附属公共卫生临床中心中医科 [3]复旦大学附属公共卫生临床中心肝炎一科

出　　处：《中华传染病杂志》2016年第1期6-9,共4页Chinese Journal of Infectious Diseases

基　　金：基金项目：国家科技重大专项（2013ZX10005002）;上海市科委“科技创新行动计划”医学和农业领域重点项目（13401902100）;上海申康医院发展中心市级医院新兴前沿技术联合攻关项目（SHDC12015129）

摘　　要：目的比较聚乙二醇干扰素α-2a（PegIFNα-2a）联合利巴韦林（RBV）治疗HBV／HCV重叠感染者和HCV感染者的疗效及病毒学应答情况。方法HBV／HCV重叠感染者16例，HCV感染者32例。比较PegIFNα-2a联合RBV治疗后，两组疗效及病毒学应答率、生物化学应答率。统计学处理采用χ^2检验和Fisher确切概率法，持续病毒学应答（SVR）的影响因素采用单因素及多因素Logistic回归分析。结果治疗前HBV／HCV重叠感染组HCVRNA中位值为6．54lgIU／mL，HCV组为6．98lgIU／mL，差异有统计学意义（Z=4．124，P〈0．01）。PegIFNα-2a联合RBV治疗后，HBV／HCV重叠感染组16例患者中获得快速病毒学应答（RVR）、早期病毒学应答（EVR）、治疗结束时病毒学应答（ETR）和SVR的例数分别为14、12、14和9例，HCV感染组分别为24、24、23和21例，差异均无统计学意义（χ^2值分别为1．011、0、1．474和0．400，均P〉0．05）；HBV／HCV重叠感染组复发5例，HCV感染组复发2例，差异有统计学意义（χ^2=4．142，P=0．042）。HBV／HCV重叠感染者治疗前HBVDNA阳性7例、HgeAg阳性7例、ALT异常13例和AST异常12例，治疗后分别为4、5、4和5例（P值分别为0．458、0．716、0．004和0．032，Fisher确切概率法）。治疗前HBsAg中位数为780IU／mL，治疗后为250IU／mL，有下降趋势，但差异无统计学意义（Z=1．826，P=0．068）。获得完全病毒学应答者4例，获得部分病毒学应答者3例；2例患者发生HBeAg血清学转换。Logistic回归分析显示，EVR为获得SVR的有利因素（OR=35．2，95％CI=3．55～349．15，P=0．002）。结论HBV／HCV重叠感染可使HCV处于相对低复制状态，PegIFNα-2a联合RBV治疗可获得病毒学应答，并对HBV有一定的抑制作用，EVR为获得SVR的有利因素。Objective To analyze the virologic responses of peginterferon α-2a plus ribavirin （Peg IFNα- 2a/RBV） for patients with hepatitis B virus （HBV） and hepatitis C virus （HCV） coinfection by a paired study. Methods Sixteen patients with HBV/HCV coinfection and 32 patients with HCV monoinfection were allocated. The virological response and biochemical response were compared between the two groups after Peg IFNα-2a/ RBV regimen treatment. Chi-square analysis or Fisher exact analysis was used to compare the responses. Logistic analysis was conducted to evaluate factors associated with sustained virological response （SVR）. Results The median levels of HCV RNA were 6. 54 lg IU/mL in 16 patients with HBV/HCV co-infection and 6. 98 lg IU/mL in 32 patients of HCV monoinfection, which was statistically different （Z = 4. 124, P〈 0. 01）. Rapid virological response （RVR） was achieved in 14 cases, early virologic response （EVR） in 12 cases, end-of-treatment virological response （ETR） in 14 cases and SVR in 9 cases among patients with HBV/HCV co- infections, which were comparable to those of patients with HCV monoinfection （RVR： 24, χ^2 = 1. 011; EVR： 24, x^= 0;ETR： 23, χ^2=1. 474; SVR： 21, χ^2=0. 400, all P〉0.05）. The relapse rate in HBV/ HCV-coinfeeted patients was significantly higher than that in HCV-monoinfected patients （35.7 % [5/16] vs 8.7%[2/32];χ^2=4. 142, P=0. 042）. In HBV/HCV coinfection group, 7 cases were HBV DNA detectable, 7 cases were hepatitis B e antigen （HBeAg） positive, 13 cases were abnormal alanine aminotransferase （ALT） levels and 12 cases were abnormal aspartate aminotransferase （AST） levels. After treatment, only 4 patients were HBV DNA detectable, 5 cases were HBeAg positive, 4 cases were abnormal ALT levels and 5 cases were abnormal AST levels （P= 0. 458, 0. 716, 0. 004 and 0. 032, respectively）. The median level of hepatitis B surface antigen （HBsAg） was 780 IU/mL and decreased to 250 IU/mL after treatment, while the differen

关 键 词：聚乙二醇干扰素Α-2A 利巴韦林 肝炎病毒 乙型 肝炎病毒属 重叠感染 

分 类 号：R512.6[医药卫生—内科学]