干扰素联合利巴韦林治疗1b型丙型病毒性肝炎延长疗程至72周可获得更好的疗效

Extension of treatment with peginterferon alfa - 2a plus ribavirin to 72 weeks significantly increases the rate of sustained virologic response in patients with hepatitis C virus type 1b

目的聚乙二醇干扰素（Peg—IFN）α-2a联合利巴韦林治疗1b型慢性丙型病毒性肝炎患者，延长疗程至72周与标准治疗的48周疗程比较，是否获得更高的持续病毒学应答率（SVR）。方法113例基因型1b慢性丙型病毒性肝炎患者经知情同意分为两组，A组（疗程48周）37例，B组（疗程72周）76例，分别给予Peg—IFNα-2a联合利巴韦林抗病毒治疗，治疗结束后随访24周。分别于治疗第4、12周，治疗结束时和结束后24周检测丙型肝炎病毒（HCV）RNA。结果分析采用按意向性治疗原则（ITT）方法。结果A组与B组快速病毒学应答率（RVR）分别为78．38％（29／37）、80．26％（61／76），差异无统计学意义（P〉0．05）；早期病毒学应答率（EVR）分别为83．78％（31／37）、85．53％（65／76），差异无统计学意义（P〉0．05）；治疗结束时病毒学应答率（ETVR）分别为91．89％（34／37）、90．79％（69,／76），差异无统计学意义（P〉0．05）；SVR分别是64．86％（24／37）、84．21％（64／76），差异有统计学意义（P〈0．05）。A组与B组中取得RVR患者的SVR分别是75．86％（22／29）、95．08％（58／61），差异有统计学意义（P〈0．05）。结论对于基因型1b的丙型病毒性肝炎患者，采用Peg—IFNα-2a联合利巴韦林抗病毒治疗，不论是否取得RVR，将疗程延长至72周与标准治疗的48周比较获得更高的SVR。

Objective -To investigate whetherextension treatment of 72 weeks by using peginter- feron （Peg -IFN）α -2a plus ribavirin （RBV） for type 1 b chronic hepatitis C patients could acquire high- er sustained virologic response （SVR） rate than traditional treatment of 48 weeks or not. Methods 113 patients with genotype type 1 b chronic hepatitis C were divided into group A （48 weeks, n = 37） and group B （72 weeks,n =76） by informed consent with the treatment of Peg - IFNα- 2a plus ribavirin. All the pa- tients were followed - up for 24 weeks after the end of treatment. Hepatitis C virus （HCV） RNA was re- spectively detected at 4th week, and 12th week during the treatment, the end of treatment and 24 weeks af- ter the treatment. Outcomes analysis was conducted according to intention - to - treat principles. Results There was no statistically significant difference between group A and group B in rapid virologic response （RVR） rate （78. 38% vs. 80. 26% ）, early virologic response （EVR） rate （83.78% vs. 85.53% ） and end - of - treatment virologic response （ETVR） rate （91.89 % vs. 90.79 ） （ P 〉 0. 05）. But the SVR rate in group B （ 84. 21%, 64/76） was higher than in group A （64. 86%, 24/37 ） （ P 〈 0. 05 ）. The SVR rate in achieving RVR patients of group B （95.08%, 58/61） was also higher than in group A （75.86%, 22/29, P 〈 0. 05 ）. Conclusion Extension of treatment with Peg - IFNα - 2a plus ribavirin from 48 weeks to 72 weeks could increase the rate of SVR in patients who achieved RVR or not.