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目的观察聚乙二醇化干扰素(PegIFN)α-2a、PegIFN-α-2b和干扰素(IFN)α-2b联合利巴韦林治疗慢性丙型肝炎(CHC)患者的疗效。方法回顾性观察278例CHC患者的临床资料,分为接受PegIFN-α-2a、PegIFN-α-2b和IFN-α-2b联合利巴韦林抗病毒治疗组。比较患者治疗前、治疗第4、12、24、48周时各组患者HCV基因分型、HCV RNA载量、ALT和AST的变化。分析各组患者治疗期间ALT/AST复常率、病毒学应答,不同基因型或HCV RNA载量与病毒学应答的相关性。结果停药后随访24周时,各治疗组患者肝功能复常率差异具有统计学意义(χ~2=23.06、P<0.001),以PegIFN-α-2a(180μg)组与PegIFN-α-2b(80μg)组患者复常率较高(分别为76.7%和83.0%)。各治疗组患者快速病毒学应答(RVR)、治疗结束时病毒学应答(ETVR)及持续病毒学应答(SVR)差异均具有统计学意义(χ~2=9.79、P=0.04,χ~2=11.33、P=0.02,χ~2=11.99、P=0.02),以PegIFN-α-2a(180μg)组与PegIFN-α-2b(80μg)组患者较高(分别为62.8%、88.4%、64.0%和64.2%、83.0%、65.1%)。普通IFN-α-2b(600万单位)组、PegIFN-α-2a(180μg)组、PegIFN-α-2b(80μg)组患者依次有13例、54例和68例获得RVR,依次有11例(84.6%)、50例(92.6%)和62例(91.2%)最终获得SVR。入组患者中1b基因型患者243例,其RVR、完全早期病毒学应答(cE VR)和SVR均优于非HCV 1b基因型患者(χ~2=8.23、P<0.001,χ~2=46.26、P=0.01,χ~2=10.22、P<0.001)。普通IFN-α-2b(600万单位)组、PegIFN-α-2a(180μg)组、PegIFN-α-2b(80μg)组低病毒载量(HCV RNA<6.0 Log_(10)拷贝/ml)患者的SVR均优于高病毒载量患者(χ~2=4.10、P=0.04,χ~2=20.89、P<0.001,χ~2=19.60、P<0.001)。结论聚乙二醇化干扰素联合利巴韦林治疗慢性丙型肝炎具有较好疗效,早期RVR对SVR的获得具有很强的预测作用,非基因HCV 1b型和低病毒载量患者疗效优于HCV 1b基因型和高病毒载量患者。
Objective To observe the curative effect of peginterferon (PegIFN) α-2a, PegIFN-α-2b and interferon α-2b combined with ribavirin in patients with chronic hepatitis C (CHC). Methods The clinical data of 278 CHC patients were retrospectively analyzed. The patients were divided into PegIFN-α-2a, PegIFN-α-2b and IFN-α-2b combined with ribavirin antiviral therapy group. The changes of HCV genotyping, HCV RNA load, ALT and AST in each group were compared before treatment, 4,12,24,48 weeks after treatment. The ALT / AST normalization rate, virological response, different genotype or HCV RNA load and virological response were analyzed during the treatment of each group. Results After 24 weeks of follow-up, there was a significant difference in the rate of liver function abnormalities among the treatment groups (χ ~ 2 = 23.06, P <0.001). PegIFN-α-2a The patients with 2b (80μg) had higher rates of recanalization (76.7% and 83.0%, respectively). The rapid virological response (RVR), ETVR and SVR in each treatment group were statistically significant (χ ~ 2 = 9.79, P = 0.04, χ ~ 2 = (62.8%, 88.4%, 64.0%, respectively) with PegIFN-α-2a (180μg) and PegIFN-α-2b % And 64.2%, 83.0%, 65.1%). There were 13 patients in the group of IFN-α-2b (6 million), PegIFN-α-2a (180μg) and 54 patients in the group of PegIFN-α-2b (84.6%), 50 (92.6%) and 62 (91.2%) patients. Among the 243 patients with genotype 1b, RVR, complete early virological response (cEVR) and SVR were superior to those with non-HCV 1b genotype (χ ~ 2 = 8.23, P <0.001, χ ~ 2 = 46.26 , P = 0.01, χ ~ 2 = 10.22, P <0.001). Patients with low viral load (HCV RNA <6.0 Log 10 copies / ml) in the normal IFN-α-2b (6 million units), PegIFN- α-2a (180 μg) and PegIFN-α-2b SVR were superior to those with high viral load (χ ~ 2 = 4.10, P = 0.04, χ ~ 2 = 20.89, P <0.001, χ ~ 2 = 19.60, P <0.001). Conclusions Pegylated interferon combined with ribavirin has a good curative effect on chronic hepatitis C, early RVR has a strong predictive value for the acquisition of SVR. The efficacy of non-gene HCV 1b and low viral load is superior to that of HCV 1b genotype and high viral load patients.