聚乙二醇干扰素联合利巴韦林治疗慢性丙型肝炎

Treatment on Patients with Chronic Hepatitis C by Peginterferon and Ribavirin

目的评价聚乙二醇(PEG)干扰素联合利巴韦林治疗慢性丙型肝炎的临床疗效。方法使用聚乙二醇干扰素α-2a(40000Mr)联合利巴韦林治疗22例慢性丙型肝炎患者,其中7例为难治性慢性丙型肝炎患者。聚乙二醇干扰素α-2a180μg,肌注,每周1次,利巴韦林按体重900～1200mg/d,口服,疗程均为48周。分别于治疗中的12周、24周、48周及治疗结束后24周评价疗效,并观察药物副反应。结果所有患者均完成治疗,在治疗结束后随访24周,持续应答率为63.6%(14/22),7例难治性慢性丙型肝炎的持续应答率为42.8%(3/7)。在治疗12周时的早期应答率为72.7%(16/22),治疗结束时的应答率为77.2%(17/22)。3例患者在随访24周内出现ALT升高,血清HCV-RNA阳转,其中1例为难治性慢性丙型肝炎患者,复发率为17.6%(3/17)。副反应主要为不同程度的血WBC、血小板、血红蛋白下降及低热、肌肉酸痛,1例患者于疗程近结束时出现甲状腺机能亢进,个别患者睡眠受影响,大多不影响治疗。结论PEG干扰素联合利巴韦林治疗慢性丙型肝炎具有较好的临床疗效,副反应较轻,患者可以耐受。

Objective To evaluate the clinical effects of combination of peginterferon and ribavirin treatment on patients with chronic hepatitis C. Method 22 patients with chronic hepatitis C were treated with peginterferon （Pegasys） and ribavirin. Among them, 7 were non-responder hepatitis C patients or had relapsed after previous conventional interferon/ribavirin combination therapy. All patients received a combination of Pegasys （180 μg/week, im） and ribavirin （900-1200 mg/d） for 48 weeks. Liver functions and the level of HCV-RNA were determined at the 12th, 24th and 48th weeks during the treatment. The early virological response （EVR） was defined as no detectable HCV RNA in serum by PCR method and with a normal liver function at the 12th week during the course of treatment. The end treatment virological response （ETVR） was defined as no detectable HCV RNA in serum by PCR method and with a normal liver function at the end of the treatment. Sustained virological response （SVR） was defined as no detectable HCV RNA in serum by PCR method and with a normal liver function at the 24th week post treatment withdrawal. The adverse effects of the treatment were evaluated at the same time. Result All patients completed the whole course of treatment. Following up studies were conducted at the 24th week after the treatment. The response rate was 63,6% （14/22）. Among the 7 non-responder patients, the response rate was 42.8% （3/7）. At the 12th week during the treatment, the EVR was 72.7% （17/22）. Three patients had an increase in ALT during the 24 weeks of treatment, in which 1 patient was non-respouder patient. The replase rate was 17.6%. HCV- RNA was found in the serum. The major adverse effects were the reduction of WBC, platelet and Hb. Other adverse effects were mild fever and muscle sore. 1 patient suffered from hyperthyroidism at the end of treatment. Sleep quality was affected in some patients. Conclusion Combination of peginterferon and ribavirin may be used for the treatment of patients with chronic hepatitis C. The treatment is also well tolerated.