慢性丙型肝炎抗病毒治疗后复发的影响因素分析

周友乾; 尹凤鸣; 冯经华

慢性丙型肝炎抗病毒治疗后复发的影响因素分析

解放军第169中心医院感染内科

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中图分类号: R512.63
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出版历程
- 出版日期: 2012-08-20

Regularity of relapse after antiviral treatment in patients with chronic hepatitis C

摘要

摘要: 目的探讨慢性丙型肝炎(CHC)抗病毒治疗后复发的预测因素及时间规律。方法聚乙二醇干扰素联合利巴韦林治疗CHC。荧光定量PCR法检测HCV RNA,CE1区测序法检测HCV基因型。结果 113例患者中有100例获得治疗末病毒学应答,14例复发。HCV1型复发率(21.6%)高于HCV2型(13.3%)、HCV3型(10.3%)和HCV6型(5.3%)(P=0.345)。年龄≤40岁的复发率(10.8%)低于年龄>40岁者(20.6%);男性(9.8%)低于女性(20.5%),高ALT(8.6%)低于低ALT(21.4%),但差异均无统计学意义(P=0.204、0.133、0.068)。高HCV RNA的复发率(14.3%)与低HCV RNA(13.7%)相近(P=0.936)。获得完全快速病毒学应答(RVR)的复发率(8.5%)低于仅获得部分RVR(23.1%)和未获得RVR(33.3%);获得完全早期病毒学应答(EVR)(13.7%)低于仅获得部分EVR(50.0%);但差异均无统计学意义(P=0.174、0.148)。停药后3个月内复发多见,未见停药6个月以上复发者。结论治疗过...
- 肝炎,丙型,慢性 /
- 复发 /
- 基因型 /
- 抗病毒药
Abstract: Objective To investigate potential predictive factors of relapse after antiviral treatment in patients with chronic hepatitis C virus (HCV) infection, and explore the temporal characteristics of relapse. Methods One-hundred-and-thirteen patients with chronic HCV received pegylated interferon and ribavirin combination therapy.HCV1 type was treated for 48 weeks and non-HCV1 types were treated for 24 weeks.Serum HCV RNA was measured with real-time quantitative reverse-transcription polymerase chain reaction.HCV genotypes were determined by sequencing of the HCV core-envelope1 region, followed by phylogenic analysis. Results The majority (88.5%, 100/113) of patients achieved virological response, and 14.0% (14/100) relapsed after stopping treatment.The rate of relapse was higher for HCV1 infections (21.6%) than for HCV2 (13.3%) , HCV3 (10.3%) , or HCV6 (5.3%) infections, but the differences were not statistically significant (P=0.345) .The rate of relapse was lower in patients ≤40 years old (10.8% vs >40 years old: 20.6%) , men (9.8% vs women: 20.5%) , and patients with elevated alanine aminotransferase (>80 U/mL: 8.6% vs 80 U/mL: 21.4%) , but the differences were not statistically significant (P=0.204, P=0.133, and P=0.068, respectively) .Patients with higher HCV RNA (14.3%) experienced similar relapse rates to those with lower HCV RNA (13.7%, P=0.936) .Patients who achieved complete rapid virological response (8.5%) had lower relapse rate than those with partial rapid virological response (23.1%) and those with no rapid virological response (33.3%) , while patients who achieved complete early virological response (13.7%) also had lower relapse rate than those with partial early virological response (50.0%) ;however, none of the intergroup differences were statistically significant (rapid: P=0.174 and early: P=0.148) .Most relapses occured in less than three months after stopping treatment, and no relapses occured more than six months after stopping treatment. Conclusion Relapse in chronic HCV patients occured within six months after discontinuation of pegylated interferon and ribavirin treatment.HCV patients, especially those with HCV1, should be carefully monitored by HCV RNA quantitative examination after stopping treatment to detect recurrence in a timely manner.
- hepatitis C /
- chronic /
- recurrence /
- genotype

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参考文献(10)

[1]陈晓云, 张永宏, 马丽娜, 等.复发和无应答慢性丙型肝炎患者再治疗的临床疗效分析[J].临床肝胆病杂志, 2011, 27 (12) :1291-1295.

[2]朱研, 毛青, 张长江, 等.聚乙二醇干扰素α-2a/2b联合利巴韦林复治慢性丙型肝炎患者的疗效观察[J].临床肝胆病杂志, 2011, 27 (1) :86-88.

[3]张帆, 王小红, 王宇明, 等.重庆地区HCV基因亚型的分布状态[J].第四军医大学学报, 2005, 26 (14) :1253-1256.

[4]周友乾, 王小红, 范熠, 等.抗丙型肝炎病毒治疗中的病毒学应答对持续应答的预测价值[J].中华肝脏病杂志, 2009, 17 (12) :944-946.

[5]Nguyen-Khac E, Capron D, Castelain S, et al.Personalizedtherapy for chronic viral hepatitis C in the naive patient:Howcan we optimize treatment duration as a function of viral gen-otype?[J].Eur J Intern Med, 2007, 18 (7) :510-515.

[6]李巧于, 郭垫, 曾菲, 等.α-1b干扰素联合利巴韦林治疗丙型肝炎临床观察[J].实用肝脏病杂志, 2010, 13 (4) :302.

[7]Moreno C, Deltenre P, Pawlotsky J-M, et al.Shortenedtreatment duration in treatment-naive genotype 1 HCV pa-tients with rapid virological response:A meta-analysis[J].J Hepato, 2010, 52 (1) :25-31.

[8]王自林, 宣艳, 王丽莉, 等.丙型肝炎病毒基因型与抗病毒治疗[J].实用肝脏病杂志, 2010, 13 (2) :154-157.

[9]Yu JW, Wang GQ, Sun LJ, et al.Predictive value of rapidvirological response and early virological response on sus-tained virological response in HCV patients treated with pegy-lated interferon alpha-2a and ribavirin[J].J GastroenterolHepatol, 2007, 22 (6) :832-836.

[10]Marcellin P, Heathcote EJ, CraxìA.Which patients with genotype1 chronic hepatitis C can benefit from prolonged treatment withthe‘accordion’regimen?[J]J Hepatol, 2007, 47 (4) :580-587.

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