难治性丙型肝炎HCV基因型临床特征及芪术冲剂抗病毒疗效观察

Clinical Characteristics of HCV Genotype of Refractory Hepatitis C and its Effect on Antiviral Function of Qizhu Granule

目的探讨难治性丙型肝炎HCV基因型临床特征及芪术冲剂抗病毒疗效观察。方法将入组的204例难治性丙型肝炎患者采用SANGER测序法进行病毒基因型分析,并按1∶1比例随机分为治疗组和对照组,治疗组予芪术冲剂(治疗过程中的兼夹证进行固定药物和固定剂量的随证加味)治疗,对照组予安慰剂,治疗疗程均为48周。在第0周(治疗前)、第4周、第12周、第24周、第48周(治疗后)、第72周检测HCV RNA定量。结果在完成48周治疗的182例病例中,173例检测得基因型,其中1b型为129例,占74.6%,非1b型占26.4%。1b型和非1b型患者在性别、BMI指数及血清ALT、AST基础水平上差异无统计学意义(P>0.05),但1b型患者的病程要长于非1b型,年龄要大于非1b型,HCV RNA基础水平要高于非1b型,差别有统计学意义(P<0.05)。芪术冲剂治疗组中非1b型患者的持续病毒学应答(SVR)率为42.86%,而1b型患者的SVR率仅为9.09%,两者差异有统计学意义(P<0.05)。结论 HCV基因非1b型患者对芪术冲剂有更好的抗病毒应答,HCV基因型对中药复方抗病毒学应答存在影响。

OBJECTIVE To investigate clinical characteristics of HCV genotypes of refractory hepatitis C and its effect on antiviral function of Qizhu Granule.METHODS After virus genotypes were analyzed by SANGER sequencing before the treatment,204 patients with refractory hepatitis C were randomly and equally divided into the treatment group （Qizhu Granules）and the control group （placebo group）.Two groups received 48-week treatments.The patients＇ HCV RNA level was monitored before treatment and during the 4th,12th,24th,48th treatment,as well as 4 weeks after the treatment.RESULTS 182 patients finally received 48-week treatment and completed the study.173 cases were detected with their genotypes,including 129 case of genotype 1b for 74.6 %,and 44 cases of non-1b type for 26.4 %.No significant difference was found between genotype 1b and non-genotype 1b patients in gender,BMI index and serum ALT and AST level （P〉0.05）.Patients infected by genotype 1b virus had longer disease courses and were older than non-genotype 1b patients on average.RNA level of HCV of genotype 1b patients was higher than that of non-1b type with significant differences.SVR in the treatment group of non-genotype 1b patients was 42.86%,while that of genotype 1b was only 9.09% with statistically significance.CONCLUSION Non -1b genotype patients have better antiviral effects and HCV genotype is an important factor affecting the antiviral effect of Qizhu granules.