HCV不同基因型对慢性丙型肝炎抗病毒治疗疗效的影响

Effects of Different HCV Genotypes on the Therapeutic Efficacy of Anti-virus Treatment for Chronic Hepatitis C

目的探讨干扰素联合利巴韦林治疗慢性丙型肝炎患者临床疗效的相关影响因素.方法对110例慢性丙型肝炎患者进行PEG-IFNα-2a 180μg/周联合RBV 800~1200 mg/d的标准治疗,并完成治疗后24周随访,同时分析HCV基因型、HCV-RNA定量对持续病毒学应答（SVR）的影响.应用罗氏试剂检测丙肝病毒定量,应用反转录-套式聚合酶链反应（PT-PCR）法检测HCV基因型.结果在110例进行标准联合治疗、并完成治疗后24周随访的慢性丙型肝炎患者中,68例患者获得SVR.其中,HCV基因1b型感染者SVR率为51.4%（37/72）,HCV基因N-1b型感染者SVR率为81.5%（31/38）;基线HCV-RNA水平〈1.0×10~5IU/m L的患者SVR率为71.2%（42/59）,基线HCV-RNA水平≥1.0×10~5IU/m L的患者SVR率为50.9%（26/51）.结论非1b基因型SVR率高于1b基因型;基线低病毒RNA水平（血清HCV-RNA水平〈1.0×10~5IU/m L）SVR率高于基线高病毒RNA水平（血清HCV-RNA水平≥1.0×10~5IU/m L）.

Objective To explore the related factors of elinical curative effect of interferon combined with ribavirin on the treatment of chronic hepatitis C. Method A total of 110 patients with chronic hepatitis C who accepted standard combination therapy of pegylated interferonalpha 180 micrograms per week and ribavirin 800 1200 mg per day were enrolled in this study. After treatment,all the patients were followed up for 24 weeks. The genotypes of HCV, and the effects of HCV-RNA quantification on sustained virological response （SVR） were analyzed. The quantity of hepatitis C virus was detected by Roche reagent, and the genotypes of HCV were determined on the application of reverse transcription polymerase chain reaction （PT-PCR） method. Results Among the cases,68 patients obtained SVR. The SVR rate of the patients infected by genotype 1 b was 51.4% （37/72）,and the SVR rate in the patients infected by genotype N-lb was 81.5% （31/38）. The SVR rate in the patients with baseline HCV-RNA level less than 1.0xl05 IU/mL was 71.2% （42/59） ,and the SVR rate of the group with baseline HCV-RNA level not less than 1.0x 105 IU/mL was 50.9% （26/51）. Conclusion The SVR rate of the patients infected not by HCV-lb was higher than that of the patients infected by HCV-lb. Compared with the patients with high baseline viral RNA level （serum HCV-RNA level 〈 1.0×10^5 IU/mL） ,the SVR rate in the patients with low baseline viral RNA level （serum HCV-RNA quartile level ≥ 1.0×10^5 IU/mL） was much higher.