聚乙二醇干扰素联合利巴韦林治疗老年人慢性丙型肝炎的回顾性分析

Efficacy and safety of peginterferon combined with ribavirin for the treatment of chronic hepatitis C in elderly patients： a retrospective study

目的评价聚乙二醇干扰素（pegylatedinterferon，peg—IFN）联合利巴韦林治疗老年人慢性丙型肝炎的临床疗效和影响因素。方法纳入60岁以上老年慢性丙型肝炎患者34例，以病毒学应答、复发率及中止治疗率为评价指标，进一步分析与上述结局相关的影响因素。结果老年慢性丙型肝炎患者34例，经peg—IFN联合利巴韦林治疗后获得快速（RVR）、早期（EVR）、治疗结束（ETR）和持续病毒学应答（SVR）比例分别为26．5％、41．2％、52．9％和35．3％，复发率为33．3％。既往有干扰素（interfeon，IFN）抗病毒治疗史的患者复发率明显高于初次治疗者（P=0．022），老年慢性丙型肝炎并存糖尿病患者获得ETR、SVR的比率明显低于无糖尿病病史者（P=0．035，P=0．009）。peg—IFN与利巴韦林剂量调整的比率分别为26．5％与61．8％，二者均需调整者3例（8．8％），中止治疗者7例（20。6％）。Logistic多因素分析显示患有糖尿病老年慢性丙型肝炎患者获得SVR的比率明显低于无糖尿病者（P〈0．05）。结论peg-IFN联合利巴韦林治疗老年慢性丙型肝炎患者可获得相对较好的病毒学应答率，耐受性相对较差；有无糖尿病史可能为影响患者获得SVR的主要影响因素之一。

Objective To evaluate the efficacy and influence factors of peginterferon combined with ribavirin for the treatment of elderly patients with chronic hepatitis C （CHC）. Methods 34 CHC patients aged over 60 years were enrolled in this retrospective study. Virological responses, relapse rate and discontinuation rate were evaluated, and the predictive factors associated with these outcomes were analyzed. Results The proportions of rapid virological response （RVR）, early virological response （EVR）, end of treatment virological response（ETR）, sustained virologic response （SVR） were 26.5%, 41.2%, 52.9% and 35.3%, respectively in patients after peginterferon plus ribavirin theraphy, and the relapse rate was 33.3 %. The relapse rate was higher in patients with the interferon treatment history than in patients with initial interferon treatment （P〈0.05）. The rates of ETR and SVR were lower in CHC patients with diabetes than without diabetes （P（0.05 or 0.01）. The ratio of dose adjustment of peginterferon and ribavirin alone and in combination were 26.5% （9/ 34）, 61.8% （21/34） and 8.8% （3/34）, respectively. The discontinuation rate was 20.6% （7/34）. Multivariate Logistic regression analysis showed that SVR rate was lower in CHC patients with diabetes than in those without diabetes （P 〈 0.05）. Conclusions Peginterferon plus ribavirin therapy has a better virological response, but a poor tolerance in CHC patients. Diabetes may be an important risk factor for sustained virologic response in CHC patients.