论文部分内容阅读
目的观察慢性丙型肝炎患者个体化抗病毒治疗方案的疗效。方法选取我院2008年1月至2013年1月收治的179例慢性丙型肝炎患者,根据患者年龄、体质量、血清HCV载量和HCV基因型的不同,选择不同类型和不同剂量的干扰素联合利巴韦林治疗方案。在179例患者中,65例患者接受聚乙二醇干扰素α-2a(Peg IFNα)治疗,114例接受普通干扰素(IFNα-1b)治疗。治疗48 w,随访24 w。比较两组在不同干扰素剂量、病毒载量和不同病毒基因型患者病毒学应答率的差异。结果在随访时,65例接受Peg IFNα治疗的慢性丙型肝炎患者快速病毒学应答率(RVR)、早期病毒学应答率(EVR)和持续病毒学应答率(SVR)分别为47.7%、92.3%、93.8%,与普通干扰素1b组的58.8%、76.3%、80.7%比较,差异有统计学意义(P<0.05);43例接受常规剂量Peg IFNα-2a治疗的患者RVR、EVR和SVR分别为46.5%、97.7%和100.0%,与22例接受小剂量组的50.0%、81.8%和81.8%比,无显著性统计学差异(P>0.05);69例接受常规剂量普通干扰素治疗的患者RVR、EVR和SVR分别为60.9%、76.8%和82.6%,与45例接受小剂量组的55.6%、75.6%和77.8%比,无显著性统计学差异(P>0.05);14例接受Peg IFNα-2a治疗的血清病毒低载量患者RVR、EVR和SVR分别为64.3%、85.7%和85.7%,与51例高病毒载量组的43.1%、94.1%和96.1%比,无显著性统计学差异(P>0.05);24例接受普通干扰素治疗的血清低病毒载量患者的RVR、EVR和SVR分别为54.2%、66.7%和70.8%,与90例高病毒载量组的60.0%、78.9%和81.1%比,无显著性统计学差异(P>0.05);41例接受Peg IFNα-2a治疗的基因1型患者的RVR、EVR和SVR分别为31.7%、97.6%和97.6%,与24例非基因1型患者的75.0%、87.5%和87.5%存在显著性统计学差异(P<0.05);81例接受普通干扰素治疗的基因1型患者的RVR、EVR和SVR分别为46.9%、82.7%和87.6%,与33例非基因1型的66.7%(P<0.05)、75.7%(P>0.05)和78.8%(P>0.05)也存在差异。结论根据CHC患者的基线特征、耐受性、HCV基因型及病毒学应答出现的时间优化抗病毒治疗方案,有利于个体化治疗,以获得较高的病毒学应答率,改善预后。
Objective To observe the curative effect of individual antiviral treatment in chronic hepatitis C patients. Methods A total of 179 patients with chronic hepatitis C admitted to our hospital from January 2008 to January 2013 were enrolled in this study. According to the patients’ age, body mass, serum HCV load and HCV genotype, different types and doses of interferon Combined ribavirin treatment. Of the 179 patients, 65 received Peg IFNα and 114 received IFNα-1b. Treatment for 48 w, followed up for 24 weeks. The differences in the virological response rates among different interferon doses, viral loads and different viral genotypes were compared between the two groups. Results The rapid virologic response rate (RVR), the early virological response rate (EVR) and the sustained virological response rate (SVR) of 65 patients receiving Peg IFNα were 47.7%, 92.3% , 93.8%, respectively, which was significantly different from that of the common interferon 1b group (58.8%, 76.3%, 80.7%) (P <0.05). The mean RVR, EVR and SVR of 43 patients receiving Peg IFNα-2a (46.5%, 97.7% and 100.0%, respectively), which was not significantly different from that of the 22 patients receiving the low dose of 50.0%, 81.8% and 81.8% (P> 0.05); 69 patients received conventional interferon The RVR, EVR and SVR were 60.9%, 76.8% and 82.6% respectively, which were not significantly different from those of 45 cases receiving low dose of 55.6%, 75.6% and 77.8% (P> 0.05) The RVR, EVR and SVR of Peg IFNα-2a-treated patients with low viral load were 64.3%, 85.7% and 85.7%, respectively, compared with 43.1%, 94.1% and 96.1% of the 51 patients with high viral load (P> 0.05). The RVR, EVR and SVR were 24.2%, 66.7% and 70.8% respectively in 24 patients with low serum viral load and 90.0% in high viral load group % The mean RVR, EVR and SVR in 41 patients with genotype 1 treated with Peg IFNα-2a were 31.7%, 97.6% and 97.6% respectively, compared with 78.9% and 81.1% (P> 0.05) There were significant statistical differences in 75.0%, 87.5% and 87.5% of the 24 non-genotype 1 patients (P <0.05). The RVR, EVR and SVR in 81 patients with genotype 1 IFN treatment were 46.9% , 82.7% and 87.6% respectively, which was significantly different from that of 33 non-genotype 1 (P <0.05), 75.7% (P> 0.05) and 78.8% (P> 0.05). Conclusion Based on baseline characteristics of patients with CHC, tolerability, HCV genotypes and virological response time to optimize the anti-viral treatment program is conducive to individualized treatment in order to obtain a higher virological response rate and improve prognosis.