干扰素治疗丙型肝炎疗效预测因素的研究

The Predictive Factors of IFN Therapeutic Effectiveness in Hepatitis C

目的 :探讨能预测干扰素疗效的因素。方法 :分别应用引物特异PCR法、信号引物能量转移技术、薄板层析技术、放免法及APAAP免疫桥联酶标法检测 2 0例慢性丙型肝炎HCV基因型及干扰素治疗前后血清HCV RNA水平 ,β2 微球蛋白 ,2′ 5′寡腺苷酸合成酶活性及外周血淋巴细胞亚群。结果 :(1)疗前HCV RNA量低者及治疗和随访过程中HCV RNA量持续降低者对干扰素治疗反应好。 (2 )HCV Ⅲ型患者对干扰素完全应答率高于HCV Ⅱ型 ,P <0 .0 5。 (3)疗前 2′ 5′寡腺苷酸合成酶活性低者对IFN治疗反应好。 (4 )治疗前后血清 β2 微球蛋白水平无显著变化 ,疗前不同应答组 β2 微球蛋白水平也无显著差异。 (5 )治疗后外周血CD+3 ,CD+4 及CD+4 /CD+8升高 ,完全应答组疗前CD+3 ,CD+4 及CD+4 /CD+8较部分应答及无应答组高 ,但无统计学差异。结论 :IFN治疗前HCV RNA水平、HCV基因型、2′ 5′寡腺苷酸合成酶活性测定可作为预测IFN疗效的指标。治疗期间及随访过程中血清HCV RNA水平变化对IFN疗效评价有重要意义。疗前 β2 微球蛋白水平及淋巴细胞亚群检测不能作为预测IFN疗效的指标。

Objective: Our purpose was to study the predictive factors of interferon(IFN) therapeutic effectiveness. Methods:Genotypes of HCV, HCV RNA quantities, β 2 microglobulin, 2′ 5′oligoadenylate synthetase, and peripheral blood lymohocyte subgroup were detected by using specific primer PCR assay, energy transference technique of signal primer, sheet chromatography, radioimmunoassay, and APAAP immunoenzyme bridge technique respectively in 20 blood samples of patients with chronic hepatitis C. Results:(1)The patients who had lower level of HCV RNA before treatment and had continuing decreased HCV RNA level after treatment had good response to IFN treatment in follow up survey. (2)The patients with HCV Ⅲ type had complete response much more than those with HCV Ⅱ type (P<0.05).(3)The patients with lower level of 2′ 5′oligoadenylate synthetase before treatment might have good response to IFN treatment. (4) There was no significant change in β 2 microglobulin level before and after treatment and in different response groups before treatment.(5) The CD + 3, CD + 4, and CD + 4/CD + 8 in peripheral blood increased after treatment. The patients in complete response group had higher level CD + 3, CD + 4, and CD + 4/CD + 8 than those in part response and non response groups, but there was no significance in statisitcs. Conclusion:The HCV RNA quantities, HCV genotypes, 2′ 5′oligoadenylate synthetase level before treatment were predictive factors of IFN therapeutic effectiveness. The changes of HCV RNA level in treatment and follow up survey had important significance in therapeutic evaluation, β 2 microglobulin level, and lymphocyte subgroup before treatment were not used as predictive factors for IFN therapeutic effectiveness.