快速和早期病毒学应答对慢性丙型肝炎患者持续病毒学应答的预测价值

Prediction value of rapid virologic response and early virologic response on sustained virologic response in chronic hepatitis C patients treated with pegylated interferon α-2a and ribavirin

目的探讨快速病毒学应答（RVR）和早期病毒学应答（EVR）对慢性丙型肝炎患者持续病毒学应答（SVR）的预测价值。方法应用酶免疫方法检测105例慢性丙型肝炎患者基因型。患者给予聚乙二醇干扰素α-2a联合利巴韦林治疗。在治疗第4、12、24周和随访24周时检测患者的HCVRNA，观察不同时期的病毒学应答率以及对SVR的影响。结果105例患者中，HCV基因1型44例，占41．9％；2型46例，占43．8％；3型15例，占14．3％。基因1型患者的RVR为51．2％，明显低于基因2或3型患者的73．8％（Χ^2=5．460，P=0．019）；基因1型患者的EVR为73．2％，明显低于基因2或3型患者的96．7％（Χ^2=12．220，P=0．000）；基因1型患者的SVR为43．9％，明显低于基因2或3型患者的75．4％（Χ^2=10．413，P=0．001）。获得RVR的患者SVR为80．3％，明显高于未获得RVR的30．6％（Χ^2=24．662，P=0．000）。RVR的阳性预测值均高于EVR，RVR的阴性预测值均低于EVR，但两者相比差异无统计学意义（P〉0．05）。结论基因1型患者的RVR、EVR和SVR均明显低于基因2或3型患者，RVR、EVR和SVR与基因型相关；RVR对慢性丙型肝炎患者SVR预测价值与EVR类似。

Objective To study the value of rapid virologic response（RVR） and early virologic response（EVR） for predicting sustained virologic response（SVR） in HCV patients treated with pegylated interferon a-2a and ribavirin. Methods HCV genotypes of 105 patients were determined by enzyme-immunoassay. Patients were treated with pegylated interferon α-2a and ribavirin. HCV RNA was assessed by qualitative polymerase chain reaction（PCR） at weeks 4, 12 , 24 and follow up 24 weeks. Virologic response rates of different weeks were investigated and the predictive value of virologic response rates of different weeks on SVR was studied. Results Of 105 patients with chronic hepatitis C, 44（41.9%） were genotype 1; 46（43.8%） were genotype2; 15（14.3%） were genotype 3. RVR rate, EVR rate and SVR rate of patients with genotype 1 HCV were all significantly lower than those of patients with genotype 2 or 3 HCV（RVR rate： 51. 2% vs 73.8%, Χ^2= 5. 460, P= 0. 019; EVR rate： 73.2% vs 96.7%, Χ^2=12. 220, P=0. 000; SVR rate： 43.9% vs 75.4%, Χ^2= 10. 413, P=0.001）. The SVR rate（80. 3%） of patients who had achieved RVR was significantly higher than that of patients who had not achieved RVR（30.6%, Χ^2=24.662, P=0.000）. Positive predictive value of RVR in all patients was higher than that of EVR, but negative predictive value of RVR in all patients was lower than that of EVR, there was no significant difference between RVR and EVR. Conclusions RVR, EVR and SVR rates of patients with genotype 1 are significantly lower than those of patients with genotype 2 or 3. RVR is a similar parameter as EVR for predicting SVR.