聚乙二醇化干扰素α-2a联合利巴韦林治疗代偿期丙型肝炎肝硬化患者临床疗效研究  

Efficacy of combination of pegylated interferon-α-2a and ribavirin in treatment of patients with compensated hepatitis C cirrhosis

作　　者：杨珍杰[1] 李洪涛 王剑[3] 李霞[3] 陈媛[3] Yang Zhenjie;Li Hongtao;Wang Jian(Teaching and Research Office of Internal Medicine,Medical School,Hubei Professional Technology College,Xiaogan 432000,Hubei Province,China)

机构地区：[1]湖北职业技术学院医学院内科学教研室,湖北省孝感市432000 [2]达州市中心医院普外科 [3]华中科技大学同济医学院附属同济医院

出　　处：《实用肝脏病杂志》2019年第2期232-235,共4页Journal of Practical Hepatology

基　　金：湖北省自然科学基金资助项目(编号:615250)

摘　　要：目的探讨应用聚乙二醇化干扰素α-2a联合利巴韦林治疗代偿期丙型肝炎肝硬化患者的临床疗效。方法 2003年1月～2016年12月我院就诊的代偿期丙型肝炎肝硬化患者122例,采用随机数字表法分成两组,每组61例。给予对照组常规护肝治疗,给予观察组聚乙二醇化干扰素α-2a联合利巴韦林治疗24～48 w。随访两组24 w。采用实时荧光定量RT-PCR法检测血清HCV RNA,采用全自动生化分析仪检测血生化指标,采用化学发光法检测血清层粘连蛋白(LN)、Ⅲ型前胶原(PCⅢ)、透明质酸(HA),常规使用Fibroscan行肝脏硬度检测(LSM)。结果在治疗结束时,观察组血清HCV RNA水平为(2.0±0.4) lg IU/ml,显著低于对照组【(3.8±1.3)lg IU/ml,P<0.05】;血清AST和ALT水平分别(46.03±24.05) U/L和(36.32±20.1) U/L,显著低于对照组【(78.7±21.1)U/L和(51.2±20.9) U/L,P<0.05);观察组血清LN、PCⅢ和HA水平分别为(126.3±29.0)μg/L、(212.3±43.8)μg/L和(211.4±42.0)μg/L,均显著低于对照组【(140.3±32.1)μg/L、(267.5±39.8)μg/L和(329.6±68.4)μg/L,P<0.05】;观察组LSM为(13.6±2.4) kPa,显著低于对照组【(17.6±5.2)kPa,P<0.05】;在随访时发现,观察组血清ALT复常率和持续病毒学应答率(SVR)均显著高于对照组(分别为93.4%对45.9%和72.1%对9.8%,P<0.05),而疾病进展发生率为3.3%,显著低于对照组的13.1%(P<0.05)。结论应用聚乙二醇化干扰素α-2a联合利巴韦林抗病毒治疗代偿期丙型肝炎肝硬化患者可显著提高SVR,延缓肝纤维化进展,稳定肝功能指标。Objective To investigate the efficacy of combination of pegylated interferon-α-2a(peg-IFN-α2a)and ribavirin in treatment of patients with compensated hepatitis C cirrhosis.Methods 122 patients with compensated hepatitis C cirrhosis were recruited in our hospital between January 2003 and December 2016,and were divided randomly into control(n=61)and observation group(n=61),receiving conventional therapy or peg-IFN-α2a and ribavirin combination for 24 to 48 weeks,respectively.All patients were followed-up for 24 weeks.Serum LN,PCⅢand HA levels were assayed routinely,and liver stiffness measurement(LSM)was obtained by Fibroscan.Results At the end of the observation,serum HCV RNA load in patients receiving antiviral therapy was(2.0±0.4)lg IU/ml,much lower than【(3.8±1.3)lg IU/ml,P<0.05】in the control;serum AST and ALT levels were(46.03±24.05)U/L and(36.32±20.1)U/L,much lower than【(78.7±21.1)U/L and(51.2±20.9)U/L,P<0.05),respectively in the control;serum LN,PCⅢand HA levels were(126.3±29.0)μg/L,(212.3±43.8)μg/L and(211.4±42.0)μg/L,significantly lower than【(140.3±32.1)μg/L,(267.5±39.8)μg/L and(329.6±68.4)μg/L,P<0.05】,respectively in the control;the LSM was(13.6±2.4)kPa,much lower than【(17.6±5.2)kPa,P<0.05】in the control;at the end of 24 week follow-up,the serum ALT normalization and sustained virologic response(SVR)in the observation group were much higher than those in the control(93.4%vs.45.9%and 72.1%vs.9.8%,respectively,P<0.05),and disease progression was 3.3%,much lower than 13.1%(P<0.05)in the control.Conclusion The application of pe-IFN-α2a and ribavirin combination in treatment of patients with compensated hepatitis C liver cirrhosis is efficient which might significantly increase serum ALT normalization,improve SVR and postpone the disease progression.

关 键 词：丙型肝炎肝硬化 聚乙二醇化干扰素Α-2A 利巴韦林 治疗 

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