丙型肝炎病毒血清型对慢性丙型肝炎干扰素抗病毒疗效影响的研究

Effect of hepatitis C virus serotype on the response of patients with chronic hepatitis C to interferon treatment

目的研究丙型肝炎病毒血清型对慢性丙型肝炎于扰素抗病毒疗效的影响。方法对慢性丙型肝炎患者的血清进行ALT检测，采用Cobas amplicor monitor test，version 2．0（v2．0）试剂进行HCVRNA定量和Abbott公司的Murex HCV Serotyping 1-6 Assay试剂进行HCV血清学分型检测。对慢性丙型肝炎患者进行聚乙二醇于扰素a-2a（派罗欣）与罗荛愫（Roferon—A）治疗24周和24周随访结束的生化指标和病毒学应答进行观察，分析不同HCV血清型患者在抗病毒治疗后生化和病毒学应答的差异。结果98例患者共检出血清6型2例、5型1例、4型1例、3型10例、2型23例和1型44例，仍有17例未能分出血清型。派罗欣治疗组24周治疗结束时各血清型和未分型组之间的ALT复常率和病毒应答率无差异，而48周随访结束血清非1型的ALT复常率（76．2％）和持续病毒应答率（66．7％）高于血清1型，血清1型ALT复常率和持续病毒应答率分别为27.3％和27．3％，差异有统计学意义（P=0．035）。罗荛愫组末分型组、血清1型和非1型之间24周治疗结束时和随访结束时的ALT复常率和病毒学应答率均无差异。结论在6个月的IFN抗病毒疗程时，HCV血清型仅在派罗欣治疗组影响慢性丙型肝炎抗病毒治疗的持续病毒应答率。

Objective To investigate the influence of hepatitis C virus （HCV） serotype on the interferon （IFN） treatment of patients with chronic hepatitis C. Methods Ninety-eight patients with chronic hepatitis C were divided into two groups： patients in group 1 （n = 53） were treated with Pegasys, 180 μg injected subcutaneously once a week for 24 weeks, and those in group 2 （ n = 45） were injected with Roferon-A 3 MU three times a week for 24 weeks and then patients in both groups were followed up for another 24 weeks. The virological response at the end of follow up was the primary endpoint for evaluating the effects of IFN treatment. The HCV RNA levels of the chronic hepatitis C patients were determined with Cobas amplicor monitor test, version 2.0, and the HCV serotypes were examined by the means of ELISA using Murex HCV Serotyping 1-6 Assay. Results Of the 98 cases, HCV in 44 cases was serotype 1, in 23 was serotype 2, in 10 was serotype 3, in 1 was serotype 4, 1 was serotype 5 and in 2 was serotype 6; HCV serotypes in the remaining 17 patients could not determined. In Pegasys treatment group, the biochemical and virological response was not significantly different at the end of treatment between the patients with serotype 1 and non serotype 1 or serotype undetermined patients, but the sustained virological response rate of HCV serotype undetermined group （66.7%） was significantly higher than that of serotype 1 patients （27.3%） （P = 0.035）. In Roferon-A treatment group, the virological response rate at 24 weeks and sustained viral response rate at the end of follow-up was not significantly different between serotypo 1 and non serotype 1 patients or serotype undetermined patients. Conclusion After the six months treatment course, the HCV serotypo had some effects on the treatment response to Pegasys treatment for chronic hepatitic C.