聚乙二醇干扰素α联合利巴韦林治疗HCV基因3型感染者最适疗程的回顾性研究  

Optimal treatment course of pegylated interferon α plus ribavirin therapy for hepatitis C virus genotype 3 infection: a retrospective study

作　　者：邓玲[1] 陈娟[1] 朱研[1] 张长江[1] 张鹏[1] 王小红[1] 

机构地区：[1]第三军医大学西南医院全军感染病研究所,感染病研究重庆市重点实验室,重庆400038

出　　处：《第三军医大学学报》2016年第9期992-996,共5页Journal of Third Military Medical University

基　　金：国家自然科学基金面上项目(81171643)~~

摘　　要：目的探讨丙型肝炎病毒（hepatitis C virus,HCV）基因3型感染者聚乙二醇干扰素α（pegylated interferonα,PEG-IFN-α）联合利巴韦林（ribavirin,RBV）抗病毒治疗的最适疗程。方法收集PEG-IFN-α联合RBV治疗的HCV基因3型感染者临床资料,根据疗程、基因亚型分组,比较病毒学应答效果及不良反应。结果纳入HCV基因3型感染者150例,快速病毒学应答（rapid virological response,RVR）、持续病毒学应答（sustained virological response,SVR）分别为78.52%、90.67%。HCV3a型感染者60例,缩短疗程组、标准疗程组及延长疗程组RVR、SVR比较,无统计学差异（P〉0.05）。HCV 3b型感染者90例,缩短疗程组、标准疗程组及延长疗程组RVR分别为7/14（50.00%）、51/62（82.26%）、7/8（87.50%）,缩短疗程组RVR较其他两组明显降低,有统计学差异（χ2=7.31,P〈0.05）;SVR分别为8/15（53.33%）、63/67（94.03%）、8/8（100.00%）,缩短疗程组SVR较其他两组明显降低,有统计学差异（χ2=20.14,P〈0.01）。延长疗程组较标准疗程组无明显差异。影响因素分析中,缩短疗程是获得SVR的独立不利因素（P〈0.01,OR=11.18,95%CI 3.79~32.92）。此外,延长疗程骨髓抑制等不良反应发生率增加。结论 PEG-IFN-α联合RBV标准剂量,疗程24周,仍为HCV基因3型感染者最适治疗方案。缩短疗程会降低有效率,特别是HCV 3b型感染者。延长疗程疗效无显著提高,但骨髓抑制等不良反应增加。Objective To determine the optimal treatment duration for the patients infected with hepatitis C virus genotype 3（ HCV 3） by pegylated interferon α（ PEG-IFN-α） combined with ribavirin（ RBV）.Methods Clinical data of the patients with HCV genotype 3 infection who were treated with PEG-IFN-α plus RBV in our institute from January 2006 to December 2014 were comprehensively collected as possible as we could. According to the course of treatment,gene subtype,the cohort was divided into subgroups,and the virological responses and adverse reactions were compared among the subgroups. Results There were 150 patients enrolled in the study. The rapid virological response（ RVR） and sustained virological response（ SVR）were 78. 52% and 90. 67%,respectively in total. Among the 60 patients with HCV 3a,there were no differences in the RVR and SVR ratios among the shorten,standard and extending treatment duration groups（ P〈0. 05）. In the 90 patients with HCV 3b,the RVR ratios were 7 /14（ 50. 00%）,51 /62（ 82. 26%） and 7 /8（ 87. 50%）,while the of SVR ratios were 8 /15（ 53. 33%）,63 /67（ 94. 03%） and 8 /8（ 100. 00%）,respectively for the shorten,standard and extending treatment duration groups,both with those of shorten treatment duration group significantly lower than the other groups（ Chi square = 7. 31,P〈0. 05; Chi square = 20. 14,P〈0. 01）.No obvious difference was seen in the 2 ratios between the standard and extending duration groups. In the analysis of influencing factors,shorten duration of treatment was independent unfavorable factor for acquired SVR（ P〈0. 01,OR = 11. 18,95% CI： 3. 79 ~ 32. 92）. Moreover,extending treatment duration increased the incidence of adverse reactions. Conclusion Sufficient dose of PEG-IFN-α plus RBV therapy for 24 weeks is still the optimal treatment for the patients with HCV genotype 3 infection. Shorten duration will reduce the efficiency,especially for the patients with HCV 3b. Extending duration seems not significantly improve th

关 键 词：丙型肝炎 HCV 基因3型 聚乙二醇干扰素 利巴韦林病毒学应答 最适疗程 

分 类 号：R181.32[医药卫生—流行病学] R512.63[医药卫生—公共卫生与预防医学]