基因1型慢性丙型肝炎代偿期肝硬化患者抗病毒治疗后的长期随访研究  

Long-term follow-up study of genotype 1 patients with HCV-related compensated cirrhosis treated with pegylated interferon alpha-2a and ribavirin

作　　者：张曹庚 项晓刚[1] 刘柯慧[1] 曹竹君[1] 谢青[1] 王晖[1] 

机构地区：[1]上海交通大学附属瑞金医院感染科,200025

出　　处：《肝脏》2016年第6期434-437,共4页Chinese Hepatology

基　　金：国家自然科学基金(81570560);十二五重大专项资助项目(2012ZX10005004-002);上海市科学技术委员会科技支撑项目(13401902903);上海市卫生计划委员会重点项目(20134004);国家临床重点专科建设项目(感染病学)

摘　　要：目的探讨基因1型慢性丙型肝炎代偿期肝硬化抗病毒治疗的长期疗效。方法采用平行对照回顾性队列研究,对基因1型慢性丙型肝炎代偿期肝硬化患者予聚乙二醇干扰素α-2a联合利巴韦林（PR）治疗,予以集落刺激因子对症治疗,5年长期随访并观察其转归。评估疗效、复发率,肝脏瞬时弹性超声成像检测肝脏硬度值（Stiffness值）,比较持续病毒学应答（SVR）组和非持续病毒学应答（NSVR）组的临床事件（肝性脑病、腹水、消化道出血、肝癌或者死亡）发生。结果54例基因1型慢性丙型肝炎代偿期肝硬化患者接受了PR治疗,获得SVR的患者有35例。15例患者在第1次抗病毒治疗后获得SVR,9例、8例、2例、1例患者分别在第2、3、4、5次抗病毒治疗后获得SVR。仅有1例患者在获得SVR6周后出现复发。抗病毒治疗期间,患者的肝硬度值得到不同程度的改善,SVR组治疗后与基线值比较差异有统计学意义（P=0.0004）。结束治疗后的长期随访发现,SVR组患者的肝硬度值有进一步下降的趋势,并能保持在一个较低的水平。而NSVR组患者的肝硬度值没有改善。在平均为60个月的随访中,NSVR组新增3例肝癌患者,SVR组则无人发生。两组临床事件发生频率的差异有统计学意义[腹水：P=0.0168,RR=0.2353（95%CI 0.039~1.422）,HCC：P=0.0391,RR=0.0000]。结论对于基因1型慢性丙肝代偿期肝硬化使用聚乙二醇干扰素α-2a联合利巴韦林能有效抑制病毒,应用集落刺激因子可提高患者治疗依从性。既往治疗失败患者,多次治疗及延长疗程能提高SVR率。获得SVR后的复发率低,能减少肝癌等临床事件的发生,缓解肝硬化进展。Objective To investigate the effect and clinical outcomes on combination treatment of pegylated interferon alpha‐2a and ribavirin （PR） for hepatitis C virus （HCV） genotype 1 patients with compensated cirrhosis .Methods In our parallel retrospective cohort study ,HCV genotype 1 patients with HCV related compensated cirrhosis received PR therapy and symptomatic treatment with colony‐stimulating factors （CSF） .And the patients undertook a long‐term follow‐up for 5 years .The efficacy and recurrence rate of antiviral therapy were evaluated .Transient elastography （TE） was used in liver stiffness measurement （ LSM ） . The occurrences of clinical events , including hepatic encephalopathy , ascites , gastrointestinal bleeding ,hepatocellular carcinoma （HCC） and death ,was compared between sustained virological response （SVR） group and non‐sustained virological response （NSVR） group .Results Fifty‐four HCV genotype 1 patients with HCV related compensated cirrhosis completed the PR therapy , and 34 （64 .81% ） achieved SVR . Fourteen among 23 patients（65 .22% ） achieved SVR after the first antiviral therapy ,so did 9/14 （64 .29% ） patients after the second ,8/13 （76 .92% ） after the third ,2/3 （66 .67% ） after the forth and 1/1 （100% ） after the fifth .Only one case relapsed at 6 weeks after achievement of SVR .During the antiviral treatment period ,LSM improved to varying degrees ,which showed a significant statistical difference in SVR groups （P= 0 .0004） .During the long‐term follow‐up ,the LSM of SVR group showed a further decline and kept at a low level .However ,there was no improvement of LSM in NSVR group .During the follow‐up for 60 months on average ,there were 3 cases developing HCC in NSVR group ,while 0 in SVR group .Incidencenbsp;of clinical events ,such as ascites [P=0 .0168 ,RR= 0 .2353 （95% CI 0 .0390‐1 .422）] and HCC [P=0 .0391 ,RR= 0 . 0000] ,between the two groups showed significant difference .Conclusion PR therapy can

关 键 词：慢性丙型肝炎 肝硬化 聚乙二醇干扰素 长期随访 

分 类 号：R512.63[医药卫生—内科学] R575.2[医药卫生—临床医学]