丙型肝炎肝硬化患者抗病毒疗效的影响因素分析

Factors affecting the efficacy of antiviral treatment on patients with HCV-related cirrhosis

目的探讨丙型肝炎肝硬化抗病毒治疗疗效影响因素。方法以干扰素(interferon,IFN)α为基础抗病毒治疗的丙型肝炎肝硬化患者作为研究对象,收集其流行病学资料、基线的相关化验指标、抗病毒治疗方案及经过。分析抗病毒治疗后获得的持续病毒学应答(sustained virological response,SVR)率及其影响因素。结果 28例经IFNα联合利巴韦林抗病毒治疗的丙型肝炎肝硬化患者入选,9例获得了SVR,占32.1%。SVR组和非持续病毒学应答(non-SVR,N-SVR)组基线性别比例、年龄、感染时限、HCVRNA、转氨酶、中性粒细胞绝对计数、HGB、PLT和Child-Pugh评分均无统计学差异(P>0.05)。应用聚乙二醇干扰素(pegylated interferon,Peg-IFN)α患者的SVR率高于普通IFNα(P=0.003),但去除中途脱落的患者后2组SVR率的差异无统计意义(P=0.308)。依从性好的患者SVR率显著高于依从性差的患者(P=0.004)。普通IFNα治疗的患者终止治疗的比例显著高于Peg-IFNα(P=0.009),Child-Pugh评分高的患者终止治疗的比例显著高于Child-Pugh评分低的患者(P=0.034)。结论丙型肝炎肝硬化患者抗病毒治疗的SVR率较低,主要与其依从性差有关,而依从性与干扰素类型和肝硬化的严重程度有关。

Objective To investigate the factors affecting the efficacy of antiviral treatment on patients with HCV-related cirr- hosis. Methods The patients with HCV-related cirrhosis receiving antiviral treatment based on interferon （IFN） α were enrolled in the study. Epidemiological data, laboratory indicators at baseline and antiviral protocols were collected. The rate of sustained virological response （SVR） and the factors affecting SVR rate were analyzed. Results Of 28 eligible patients with HCV-related cirrhosis receiving IFN α combined with ribavirin, 9 （32.1%） obtained SVR. The ratio of males to females, age, infection duration, HCV RNA level, ALT/AST, absolute neutrophil count, HGB, PLT and Child-Pugh score at baseline in SVR group were not signi- ficantly different from those in non-SVR group （P〉0.05）. The SVR rate of patients receiving pegylated interferon （Peg-IFN） α was significantly higher than that of patients receiving IFN α （P=0.003）, but the difference between them was not significant when excluding those patients discontinuing the therapy （P=0.308）. The patients with good medication adherence had significantly higher SVR rate than those with poor medication adherence （P=0.004）. The percentage of the patients terminating therapy with IFN α was significantly higher than that of the patients terminating therapy with Peg-IFN ot （P=0.009）. The percentage of the patients with high Child-Pugh scores was significantly higher than that of the patients with low Child-Pugh scores （P=0.034）. Conclusions The SVR rate is low in patients with HCV-related cirrhosis, which is mainly associated with poor medication adherence, and the medication adherence is associated with the type of IFN and the severity of liver cirrhosis.