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目的探讨丙型肝炎病毒(hepatitis C virus,HCV)基因3型感染者聚乙二醇干扰素α(pegylated interferonα,PEG-IFN-α)联合利巴韦林(ribavirin,RBV)抗病毒治疗的最适疗程。方法收集PEG-IFN-α联合RBV治疗的HCV基因3型感染者临床资料,根据疗程、基因亚型分组,比较病毒学应答效果及不良反应。结果纳入HCV基因3型感染者150例,快速病毒学应答(rapid virological response,RVR)、持续病毒学应答(sustained virological response,SVR)分别为78.52%、90.67%。HCV3a型感染者60例,缩短疗程组、标准疗程组及延长疗程组RVR、SVR比较,无统计学差异(P>0.05)。HCV 3b型感染者90例,缩短疗程组、标准疗程组及延长疗程组RVR分别为7/14(50.00%)、51/62(82.26%)、7/8(87.50%),缩短疗程组RVR较其他两组明显降低,有统计学差异(χ2=7.31,P<0.05);SVR分别为8/15(53.33%)、63/67(94.03%)、8/8(100.00%),缩短疗程组SVR较其他两组明显降低,有统计学差异(χ2=20.14,P<0.01)。延长疗程组较标准疗程组无明显差异。影响因素分析中,缩短疗程是获得SVR的独立不利因素(P<0.01,OR=11.18,95%CI 3.79~32.92)。此外,延长疗程骨髓抑制等不良反应发生率增加。结论 PEG-IFN-α联合RBV标准剂量,疗程24周,仍为HCV基因3型感染者最适治疗方案。缩短疗程会降低有效率,特别是HCV 3b型感染者。延长疗程疗效无显著提高,但骨髓抑制等不良反应增加。
Objective To investigate the effect of pegylated interferon α (PEG-IFN-α) combined with ribavirin (RBV) antiviral therapy on hepatitis C virus (HCV) Suitable treatment. Methods The clinical data of HCV genotype 3 infected with PEG-IFN-α plus RBV were collected and divided into groups according to the course of treatment and genotypes. The effects of virological response and adverse reactions were compared. Results 150 cases of HCV genotype 3 infection were included. The rapid virological response (RVR) and sustained virological response (SVR) were 78.52% and 90.67% respectively. There was no significant difference in the RVR and SVR among the 60 patients with HCV3a infection, shortened course, standard course and prolonged course of treatment (P> 0.05). The RVR of 90 patients with HCV 3b infection were 7/14 (50.00%), 51/62 (82.26%), 7/8 (87.50%) in shortening course, standard course and prolonged course of treatment, (Χ2 = 7.31, P <0.05); SVR were 8/15 (53.33%), 63/67 (94.03%) and 8/8 (100.00%) respectively, shortening the course of treatment Group SVR was significantly lower than the other two groups, with statistical differences (χ2 = 20.14, P <0.01). Prolonged course of treatment than the standard course of treatment no significant difference. In the analysis of influencing factors, shortening the course of treatment was an independent negative factor for achieving SVR (P <0.01, OR = 11.18, 95% CI 3.79 to 32.92). In addition, prolonged treatment of bone marrow suppression and other adverse reactions increased. Conclusion PEG-IFN-α combined with RBV standard dose, 24 weeks of treatment, HCV genotype 3 is still the most appropriate treatment options. Shorten the course of treatment will reduce the efficiency, especially HCV 3b infection. Prolonged course of treatment without significant improvement, but bone marrow suppression and other adverse reactions increased.