干扰素治疗慢性丙型肝炎的影响因素剖析

ANALYSING FACTORS WHICH INFLUENCED THE RESPONSE OF INTERFERON THERAPY TO CHRONIC HEPATITIS C

目的探讨影响慢性丙型肝炎干扰素治疗效果的因素。方法以干扰素-α2a(IFN-α2a)300万单位(11μg)或重组复合干扰素(CIFN)900万单位(9μg)或1500万单位(15μg)治疗一组慢性丙型肝炎患者,分析年龄、病程、治疗前ALT 水平、组织活动度、肝组织中病毒和 Fas 抗原表达以及干扰素类型和剂量与干扰素应答间的关系。结果患者年龄较大、病程较长为影响近期疗效的不利因素;组织 Fas 抗原表达较强者近期效果较好;与远期疗效有关的因素包括年龄及组织 Fas 表达强度,此外,CIFN 的远期效果优于 IFN-α2a。治疗前 ALT 水平、组织活动度(包括炎症活动指数和纤维化指数)、组织中病毒表达等与疗效无明显关系;CIFN 900万单位和1500万单位的治疗效果无明显差别。结论患者年龄、病程及肝组织中 Fas 抗原表达状况可影响干扰素治疗慢性丙型肝炎的疗效;CIFN 的远期治疗效果优于 IFN-α2a。

Objective To analyse the factors which might influence the response of interferon(IFN) therapy to chronic hepatitis C(CHC).Methods 29 subjects with CHC were randomized to receive consensus interferon (CIFN) 15 or 9 μg,and interferon-α2a 11 μg subcutaneously,3 times a week for 24 weeks followed by another 24 weeks post-treatment observation,respectively.The relation of the re- sponse to IFN treatment with patient's age,duration of liver disease,pretreatment ALT level,knodell's histology activity index (HAI),viral and Fas antigen expression level in liver,and the dosage and type of IFN were studied.Results To the short response of IFN treatment,the old age of patients and the long duration of liver diseases had a disadvantage influence,while liver Fas antigen expression had advantageous influence.To the long term response,the relation of the effect of IFN therapy with the age of patients and the expression of Fas antigen were the same with that to the short response of IFN treatment,and the non-response rate to CIFN was lower than that to IFN-α2a.No relations were found between the effect of IFN treatment and pretreatment ALT level,HAI score,and viral expression in liver.Conclusion Patient's age,duration of liver disease,and Fas antigen expression could influence the effect of IFN treatment.CIFN seemed to have better long-term response than IFN-α2a.