聚乙二醇干扰素加利巴韦林治疗慢性丙型肝炎疗效影响因素分析

Factors influencing the efficacy of pegylated interferon alpha-2a plus ribavirin therapy for chronic hepatitis C

目的研究聚乙二醇干扰素α-2a联合利巴韦林治疗慢性丙型肝炎(丙肝)疗效的影响因素。方法 101例慢性丙肝患者均给予聚乙二醇干扰素α-2a180μg/周联合利巴韦林10.6～15.0mg/(kg·d),疗程48周,分析性别、体重指数(body mass index,BMI)、初始HCV RNA定量、ALT及GLU等对持续病毒学应答(sustained virologic response,SVR)的影响。结果聚乙二醇干扰素α-2a联合利巴韦林治疗慢性丙肝总的SVR率为50%,其中获得快速病毒学应答(rapid virologic response,RVR)和早期病毒学应答(early virologic response,EVR)患者实现SVR达100%,未获得RVR和EVR患者实现SVR为19.35%;高BMI值、发生脂肪肝的患者不容易达到SVR,而糖化血红蛋白、初始HCV RNA载量高、GLU、ALT及性别对SVR无影响。结论 RVR、EVR可以预测SVR;BMI、是否合并脂肪肝是聚乙二醇干扰素α-2a联合利巴韦林治疗慢性丙肝获得SVR的影响因素。

Objective To investigate the factors influencing the efficacy of pegylated interferon alpha-2a plus ribavirin therapy for the patients chronically infected with hepatitis C virus （HCV）. Methods A total of 101 patients with chronic HCV infection were treated with pegylated interferon alpha-2a （180μg weekly） plus ribavirin [10.6-15.0 mg/（kg.d）] for 48 weeks. The impact of gen- der, body mass index （BMI） value, initial HCV RNA level, alanine aminotransferase （ALT） and glucose （GLU） on the sustained virologic response （SVR） were analyzed. Results By intent-to-treat analysis, the SVR rate of pegylatcd interferon alpha-2a plus ribavirin therapy was 50%. Each patient, who achieved rapid virologic response （RVR） and early virologic response （EVR）, achieved SVR ultimately. The SVR rate in the patients who failed to achieve RVR or EVR was 19.35%. The patients with high BMI value and fatty liver weren＇t liable to achieve SVR. Glycosylated hemoglobin Alc, high level of initial HCV RNA, GLU, ALT and gender had no effect on SVR. Conclusions RVR and EVR can be relevant predictors for SVR to pegylated interferon alpha-2a plus ribavirin therapy for chronic hepatitis C. BMI value and fatty liver are shown to be the factors influencing the efficacy of the combination therapy.