冷球蛋白血症对丙型肝炎患者病毒学应答的影响

The effect of cryoglobulinemia on the anfiviral therapy in patients with chronic hepatitis C

目的 探讨在应用聚乙二醇干扰素α-2a联合利巴韦林抗病毒治疗的慢性丙型肝炎（CHC）患者中，冷球蛋白血症对抗病毒治疗效果的影响。方法40例接受聚乙二醇干扰素α-2a联合利巴韦林抗病毒治疗的CHC患者进入研究，检测HCV基因型与基线、用药后4周、12周及治疗结束后24周患者血清HCVRNA水平，并检测基线患者血清中的冷球蛋白。连续型变量用独立样本t检验或秩和检验，分类资料用，检验或Fisher’S精确概率法，对抗病毒治疗效果相关影响因素的分析用多元logistic回归分析。结果治疗4周后快速病毒学应答发生率在冷球蛋白阳性患者（6／18，33．3％）低于阴性患者（15／22，68．2％，P=0．028）。冷球蛋白阳性患者的持续病毒学应答发生率也低于阴性患者（0对比6／6，P=0．012）。结论冷球蛋白阳性的CHC患者快速病毒学及持续病毒学应答疗效低于冷球蛋白阴性的CHC患者。

Objective To investigate the possible influence of cryoglobulinemia on the antiviral effect in chronic hepatitis C patients, who were treated with combination therapy of pegylated interferon alpha-2a and ribavirin. Methods Forty consecutive patients with chronic hepatitis C （CHC） were enrolled in the study. They received pegylated interferon alfa-2a （40kD, 180μg/w） along with ribavirin. Baseline cryoglobulins were detected in the sera by cryoprecitation. Hepatitis C virus （HCV） genotyping was performed and HCV viral load was detected at baseline, and at 4, 12 weeks during treatment, 24 weeks after cessation of treatment. Results Eighteen （45.0%） patients infected with HCV were cryoglobulins positive at baseline. Mean serum HCV RNA level in cryoglobulins positive patients was higher than that in cryoglobulins negative patients （6.36 ± 0.63 vs. 5.70 ±1.20, P-0.032）. The rapid virological response （RVR） rate was statically different between cryoglobulins positive patients and cryoglobulins negative ones （6/18, 33.3% vs. 15/22, 68.2%, P= 0.028）. In contrast, no difference was found in early virological response （EVR） rate between the cryoglobulins positive patients and cryoglobulins negative ones （14/17, 82.4% vs. 18/21, 85.7%, P= 1.0）. Sustained virological response （SVR） rate in cryoglobulins positive and cryoglobulins negative was different （0/3, 0 vs 6/6, 100%, P=0.012）. The rate of patients achieved RVR was different between the patients infected with HCV genotype 1 b of two groups （cryoglobulins positive： 2/13, 15.4% vs cryoglobulins negative 14/21; 66.7%, P= 0.005）.However, the rate of EVR in patients infected HCV genotype 1 b was not statistically different （cryoglobulins positive： 9/12, 75.0% vs. cryoglobulins negative 17/20; 81.2%,P=0.647）. Conclusion The rates of RVRand SVR achievement in cryoglobulinemia positive CHC patients are lower than those in cryoglobulinemia negative CHC patients.