不同HCV基因型感染的慢性丙型肝炎和肝硬化患者对重组人干扰素α-2a治疗应答的影响  

Impact of HCV genotypes on the treatment response of recombinant human interferonα-2a in patients with chronic hepatitis C and hepatitis C liver cirrhosis

作　　者：束青华 张楠楠 葛勇胜[3] Shu Qinghua;Zhang Nannan;Ge Yongsheng(Department of Hepatobiliary and Pancreatic Surgery,Socond Hospital Affiliated to Nanjing University of Traditional Chinese Medicine,Nanjing 210003,Jiangsu Province,China)

机构地区：[1]南京中医药大学附属南京医院/南京市第二医院肝胆胰外科,南京市210003 [2]南京医科大学附属老年医院消化内科 [3]安徽省立医院肝脏外科

出　　处：《实用肝脏病杂志》2021年第6期899-902,共4页Journal of Practical Hepatology

摘　　要：目的研究丙型肝炎病毒(HCV)基因型对慢性丙型肝炎(CHC)和丙型肝炎肝硬化患者接受干扰素α-2a治疗的影响。方法2015年1月~2020年4月我院收治的CHC患者198例和丙型肝炎肝硬化患者200例,均接受肝活检和干扰素α-2a治疗24周,随访24周。采用实时荧光定量PCR法检测血清HCV RNA水平,采用基因序列测定法检测HCV基因分型,采用单因素和多因素回归分析影响治疗应答的因素。结果肝硬化组HCV基因1b型检出率为31.0%,显著高于86例≤S1的15.1%或112例S2~3组的18.8%(P<0.05);212例无应答组HCV基因1b型检出率显著高于186例治疗应答组(29.7%对17.7%),1a型检出率显著低于治疗应答组(17.9%对28.0%,P<0.05);应答组早期应答率为60.8%,显著高于无应答组的18.9%(P<0.05),应答组治疗前血清HCV RNA高水平比率为37.1%,显著低于无应答组的47.6%(P<0.05);HCV基因1b型(OR为0.553,95%CI为0.316~0.969)是影响干扰素治疗应答的危险因素,而早期应答(OR为1.704,95%CI为1.008~2.881)为影响干扰素治疗应答的保护因素。结论HCV基因型可影响干扰素α-2a治疗慢性HCV感染者的应答反应,检测病毒基因型可能对选择合适的治疗方案或疗程有指导意义。Objective The aim of this clinical trial was to investigate the impact of HCV genotypes on the treatment response of recombinant human interferon α-2a(IFN-α-2a)in patients with chronic hepatitis C(CHC)and hepatitis C liver cirrhosis.Methods A total of 198 patients with CHC and 200 patients with hepatitis C-induced liver cirrhosis were enrolled in our hospital between January 2015 and April 2020,and all received liver biopsies and IFN-α-2a treatment for 24 weeks and followed-up for 24 weeks.Serum HCV RNA loads were detected by Roche's lightcycle real-time fluorescent quantitative PCR and the HCV genotypes were detected by gene sequencing.The liver injuries were evaluated by Knodell histological activity index scoring systems.The factors impacting response to IFN-α-2a therapy was analyzed by univariate or multivariate regression analysis.Results The percentage of HCV 1b genotype in patients with liver cirrhosis was 31.0%,significantly higher than 15.1%in 86 CHC patients with less than S1 liver fibrosis or 18.8%(P<0.05)in 112 CHC patients with S2-3 liver fibrosis;the percentage of HCV 1b genotype in 212 patients without response to IFN-α-2a therapy was significantly higher than(29.7%vs.17.7%),and the percentage of genotype 1a was significantly lower than(17.9%vs.28.0%,P<0.05)in 186 responders;the early virological response rate in responders was 60.8%,significantly higher than 18.9%(P<0.05),and high serum HCV RNA loads was 37.1%,significantly lower than 47.6%(P<0.05)in non-responders;the HCV 1b genotype(OR:0.553,95%CI:0.316-0.969)was the independent risk factor,while the early response(OR:1.704,95%CI:1.008-2.881)was the protective factor for response to IFN-α-2a therapy.Conclusion The detection of HCV genotype could predict the response to IFN-α-2a therapy in patients with CHC and CHC-induced liver cirrhosis,which might guide the selection of antiviral therapy strategy and the treatment period.

关 键 词：肝硬化 慢性丙型肝炎 干扰素Α-2A 丙型肝炎病毒基因型 治疗应答 

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