慢性丙型肝炎患者获得快速病毒学应答的预测因素分析

Analysis of predictive factors for rapid virologic response in treating patients with chronic hepatitis C

目的：探讨联合应用聚乙二醇干扰素（PEG－IFN）和利巴韦林治疗的慢性丙型肝炎（CHC）患者获得快速病毒学应答（RVR）的预测因素。方法采用回顾性队列研究方法，对上海市公共卫生临床中心肝病科2010－2012年收治的127例接受PEG－IFN联合利巴韦林治疗的CHC患者进行分析，根据抗病毒治疗4周后是否获得RVR，将研究对象分为RVR组和无快速病毒学应答（NRVR）组，比较两组人口学特征及治疗前的临床特征，分析影响CHC患者获得RVR的可能因素。计数资料采用卡方检验，影响因素的分析采用两个独立样本的非参数检验即Mann－Whitney U检验，独立预测因素采用单因素及多因素Logistic回归分析，预测因素中的连续变量作ROC曲线分析。结果127例患者中，男86例，女41例，其中明确诊断为肝硬化的11例。127例中100例（78．74％）获得RVR，NRVR患者27例（21．26％）。非参数分析显示，对于患者年龄、感染时间、基线ALT水平、基线HA水平、是否合并高血压病、干扰素种类、感染途径、病毒基因型这些因素，RVR组和NRVR组差异均有统计学意义（P值均＜0．05）。Logistic回归分析显示，感染时间、是否合并高血压、HCV基因型是能否获得RVR的独立预测因子，非基因1型在RVR的OR值为0．203（95％CI：0．051～0．802， P＜0．05），感染时间在RVR的OR值为0．925（95％CI：0．868～0．987，P＜0．05），不合并高血压在RVR的OR值为0．129（95％CI：0.032～0．521，P＜0．05）。结论感染时间较短、不合并高血压病、非基因1型的患者可能更易获得RVR。

Objective To analyze the predictive factors for rapid virologic response （RVR）in patients with chronic hepatitis C （CHC）who received combination therapy with pegylated interferon （PEG-IFN）and ribavirin.Methods A total of 127 CHC patients who were admitted to our department from 2010 to 2012 and received PEG-IFN combined with ribavirin were enrolled in this retrospective cohort study.The pa-tients were divided into RVR group and non-RVR （NRVR）group according to their virologic responses after 4 weeks of antiviral therapy. Demographic characteristics and the clinical features prior to treatment were compared between the two groups,and the potential factors that contributed to the acquisition of RVR were analyzed.Comparison of categorical data between groups was made by chi-square test,predictive factors were analyzed by nonparametric test for two independent samples （Mann-Whitney U test）,independent predictive factors were tested by univariate and multivariate logistic regression analyses,and the continuous variables of predictive factors were analyzed using receiver oper-ating characteristic curves.Results Of the 127 CHC patients,86 were males and 41 females.There were 1 1 confirmed cases of liver cirrho-sis.There were 100 patients （78.74%）who achieved an RVR,and 27 （21.26%）with NRVR.Nonparametric analysis showed that eight fac-tors,which were age,time of infection,level of pre-treatment alanine aminotransferase,level of pre-treatment hyaluronic acid,development of hypertension,type of interferon,pathway of infection,and hepatitis C virus （HCV）genotype,were significantly different between the RVR and NRVR groups （P＆lt;0.05）.The logistic regression analysis identified the following factors as independent predictive factors for RVR：non-genotype 1 （OR：0.203,95%CI：0.051 -0.802,P＆lt;0.05）,time of infection （OR：0.925,95%CI：0.868-0.987,P＆lt;0.05）,and ab-sence of hypertension （OR：0.129,95%CI：0.032-0.521,P＆lt;0.05）.Conclusion Patients with shorter history of HCV infection,absence of complicated hypertension,and non-genotype 1 HCV infection have an increased likelihood of achieving an RVR.