基因1型慢性丙型肝炎慢应答患者复发与疗程相关性的探讨

Relevance between relapse and course of treatment in genotype 1 chronic hepatitis C patients with slow virologic response

目的探讨基因1型慢性丙型肝炎(CHC)慢应答患者复发与疗程的相关性。方法收集2010年4月-2013年3月焦作市第三人民医院、焦作市人民医院住院或门诊的基因1型CHC患者157例,采用干扰素α-1b联合利巴韦林治疗,其中51例获得慢应答患者在治疗6个月时随机分为A(24例)、B(27例)两组,分别继续原方案治疗6、12个月,停药后随访1年。观察不良反应对抗病毒治疗方案的影响,比较两组治疗结束时HCV RNA阴转率、ALT复常率,停药后6个月、1年的复发率及ALT复常率。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验。结果治疗中两组患者不良反应的发生率比较,差异均无统计学意义(P值均>0.05)。治疗结束时两组患者HCV RNA阴转率(95.65%vs 92.59%)、ALT复常率(95.65%vs 88.89%)比较差异均无统计学意义(χ2值分别为0.02、0.13,P值均>0.05)。停药6个月、1年后,B组患者复发率均显著低于A组(20.00%vs 50.00%;36.00%vs 68.18%),差异具有统计学意义(χ2值分别为4.69、4.85,P值均<0.05);停药6个月、1年后,B组患者ALT复常率均高于A组(84.00%vs 59.09%;72.00%vs 50.00%),但差异均无统计学意义(χ2值分别为3.63、2.40,P值均>0.05)。结论基因1型CHC慢应答患者延长疗程6个月可明显减少复发。

Objective To investigate the relevance between relapse and course of treatment in genotype 1 chronic hepatitis C （CHC）pa-tients with slow virologic response.Methods Totally 157 genotype 1 CHC inpatients or outpatients were selected from the Third People′s Hospital of Jiaozuo and the People′s Hospital of Jiaozuo from April 2010 to March 2013.The patients were treated with interferon α-1b in conjunction with ribavirin.At 6 months of the initial treatment,5 1 patients with slow virologic response were randomly divided into groups A （24 cases）and B （27 cases）,which received continued treatment for another 6 and 12 months,respectively.A 1 -year follow-up of pa-tients was performed after withdrawal of treatment.Adverse reactions in patients receiving the antiviral therapy were assessed.Furthermore, group comparisons were performed on the clearance rate of hepatitis C virus （HCV）RNA and normalization rate of alanine aminotransferase （ALT）at withdrawal of treatment,as well as the CHC relapse rate and ALT normalization rate at 6 months and 1 year after withdrawal of treatment.Continuous data were compared using t test,and categorical data were compared usingχ2 test.Results The rate of adverse reac-tions in patients receiving antiviral therapy had no significant difference between groups A and B （P〉0.05 ）.At withdrawal of treatment, there were no significant differences between groups in terms of HCV RNA clearance rate （95.65%vs 92.59%）and ALT normalization rate （95.65% vs 88.89%）（χ2 =0.02 and 0.13,respectively,both P〉0.05）.At 6 months and 1 year after withdrawal of treatment,the CHC relapse rate in group B was significantly lower than that in group A （20.00% vs 50.00%,χ2 =4.69,P 0.05;72.00% vs 50.00%,χ2 =2.40,P〉0.05）.Conclusion To extend the 6 -month course of treatment can significantly reduce the relapse following slow virologic response in patients with genotype 1 CHC.