难治性丙型肝炎再认识—谈丙型肝炎抗病毒治疗策略的进展

Re- understanding of refractory hepatitis C: progress in antiviral therapy strategies for hepatitis C

丙型肝炎从病毒的发现、临床诊断，到干扰素抗病毒治疗经历了近20年的历程，取得了非常显著的成绩。从最初的单纯控制病毒，到目前的临床治愈；从单一普通干扰素治疗持续病毒学应答（SVR）率30％左右，到目前我国聚乙二醇干扰素联合利巴韦林标准治疗的SVR率70％～80％，从依赖基因型和病毒载量定义治疗的难易性，到根据宿主IL-28基因型及应答模式（RVR、cEVR）决定治疗策略，特别是近几年直接抗病毒药物的不断问世，使丙型肝炎的抗病毒治疗不论从理念上，还是临床治疗策略上都有了根本的改变。从对难治性丙型肝炎的再认识出发，系统综述丙型肝炎抗病毒治疗策略的进展。

It has been nearly 20 years from the discovery of hepatitis C virus （HCV）and clinical diagnosis of hepatitis C to antiviral therapy with interferon,and significant progress has been made.Substantial changes have taken place in both the concept and strategy for antiviral treatment of hepatitis C,with more and more direct-acting antiviral agents emerging in recent years;these changes are as follows：from the control of HCV to clinical cure,from a sustained virologic response （SVR）rate around 30%with conventional interferon therapy to an SVR rate of 70%-80% with standard therapy with pegylated interferon and ribavirin,and from evaluating the difficulty of treatment based on genotypes and viral load to determining the treatment strategy according to host IL28B genotypes and response patterns （rapid virologic re-sponse and complete early virologic response）.The progress in antiviral therapy strategies for hepatitis C is systematically reviewed for re-understanding of refractory hepatitis C.