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目的探讨丙型肝炎病毒(HCV)基因型、RNA含量与肝组织炎症活动的相关性,慢性丙型肝炎患者经干扰素治疗后复发的相关因素。方法对慢性丙型肝炎患者的血清进行丙氨酸氨基转移酶(ALT)检测,采用Cobas Amplicor Monnitour Test.version 2.0试剂进行HCV RNA定量和Simmonds酶切分型方法进行HCV基因分型检测。对聚乙二醇化干扰素α-2a(PEG-IFNα-2a)与干扰素α-2a治疗24周结束时,取得病毒学应答的慢性丙型肝炎患者进行24周随访观察,对临床特征、病毒学特征、治疗药物等因素与复发的相关性进行分析。结果208例丙型肝炎患者基础HCV RNA含量与ALT水平无相关h生(r=0.093,P＞0.05),HCV基因1型与非基因1型之间ALT的水平差异无统计学意义,HCV基因型与RNA含量无相关性；在治疗结束取得病毒学应答的119例患者中,随访24周持续应答者61例(51.3％),复发58例(48.7％)。患者的性别、年龄、HCV感染途径、既往干扰素治疗史、天冬氨酸氨基转移酶／ALT比值、血小板计数和血清基础HCV载量等因素均与复发率无显著相关性。基因1型患者复发率(54.5％)显著高于非1型(32.1％)(x~2=4.265,P=0.039)。PEG-IFNα-2a组复发率(47.0％)低于IFNα-2a组(52.8％),但差异无统计学意义。结论病毒基因型与慢性丙型肝炎干扰素治疗后的病毒复发显著相关。
Objective To investigate the relationship between hepatitis C virus (HCV) genotype, RNA content and inflammation in liver tissue and related factors of relapse after treatment with interferon in chronic hepatitis C patients. Methods Serum alanine aminotransferase (ALT) was detected in serum of patients with chronic hepatitis C, and HCV genotypes were detected by Quantitative HCV RNA assay and Enzyme digestion by Cobas Amplicor Monnitour Test.version 2.0. At the end of 24 weeks of treatment with peginterferon alfa-2a (PEG-IFNα-2a) and interferon α-2a, 24-week follow-up of patients with virological response to chronic hepatitis C was performed. Clinical characteristics, The characteristics of the study, the treatment of drugs and other factors associated with recurrence were analyzed. Results There was no significant difference in the level of ALT between 208 HCV genotypes and ALT genotypes (r = 0.093, P> 0.05). There was no significant difference in the level of ALT between HCV genotype 1 and non-genotype 1, There was no correlation between the type and RNA content. Of the 119 patients who achieved virological response at the end of treatment, 61 (51.3%) were persistent responders and 58 (48.7%) relapsed after 24 weeks of follow-up. Factors such as gender, age, HCV infection, previous history of interferon therapy, aspartate aminotransferase / ALT ratio, platelet count, and serum basal HCV load did not correlate with relapse rates. The recurrence rate (54.5%) in genotype 1 patients was significantly higher than that in non-genotype 1 patients (32.1%) (x 2 = 4.265, P = 0.039). The recurrence rate of PEG-IFNα-2a group (47.0%) was lower than that of IFNα-2a group (52.8%), but the difference was not statistically significant. Conclusions The virus genotype is significantly correlated with the virus recurrence after chronic hepatitis C interferon therapy.