自身抗体对慢性丙型病毒性肝炎疗效及安全性的影响

Effect of Autoantibody on the Therapeutic Effect and Safety for Chronic Hepatitis C

目的探讨接受聚乙二醇干扰素α-2a(Peg-IFNα-2a)联合利巴韦林治疗的慢性丙型肝炎病毒(HCV)感染患者中,自身抗体阳性对疗效以及治疗安全性的影响。方法回顾性分析2012年2月-2014年1月确诊的106例慢性丙型肝炎患者的临床资料。根据自身抗体检测情况分为自身抗体阳性组和阴性组,记录患者病毒学应答情况及对药物的反应。结果 106例慢性HCV感染者中,自身抗体阳性患者共33例,其中24例为抗核抗体阳性。自身抗体阳性组与阴性组患者间性别、年龄、谷丙转氨酶、谷草转氨酶、总胆红素、甲状腺功能、病毒基线载量之间差异无统计学意义(P>0.05)。自身抗体阳性组血红蛋白水平低于阴性组(P=0.018)。106例患者中,82例患者获得持续病毒学应答(SVR),56例获得快速病毒学应答(RVR),98例获得早期病毒学应答(EVR);8例患者治疗无应答。自身抗体阳性组与阴性组之间RVR、EVR及SVR获得率比较差别均无统计学意义(P>0.05)。两组患者治疗的常见不良反应为疲劳、体质量下降、脱发和发热,差异无统计学意义(P值均>0.05)。结论慢性丙型肝炎合并自身抗体阳性的患者接受Peg-IFNα-2a联合利巴韦林治疗是安全的;自身抗体阳性可能并非抗病毒治疗的影响因素。

Objective To evaluate the effect of autoantibody on the efficacy and safety of pegylated interferon α-2a （Peg-IFN α-2a） and ribavirin on chronic hepatitis C （HCV）. Methods We enrolled 106 chronic HCV infected patients, who were divided into autoantibody-positive group and negative group based on the baseline autoantibody detection. The patients were treated for 48 weeks. The anti-viral response and adverse effects were observed. Data analyses were reported using the SPSS 20.0 statistical package. Results The prevalence of any autoantibody in chronic hepatitis C patients amounted to 31.1%, and serum anti-nuclear antibody was positive in 24 patients. Difference in age, sex, serum alanine transaminase level, aspartate transaminase level, total bilirubin level, thyroid function and HCV RNA level between autoantibody-positive group and negative group was not significant （P 〉 0.05）. The level of hemoglobin in autoantibody- positive group was significantly lower than the negative group （P=0.018）. Of the 106 patients, 82 patients achieved sustained virological response （SVR）, 56 achieved rapid virological response （RVR）, 98 achieved ealy virological response （EVR） and 8 were non-responders. There were no significant differences between RVR, EVR and SVR in autoantibody- positive group and negative group （P 〉 0.05）. The most common adverse effects in this study were fatigue, weight loss, hair loss and fever, and no significant differences in adverse effects were observed between the two groups （P 〉 0.05）. Conclusion Autoantibody positivity may not affect the treatment response and is safe in chronic HCV infected patients with combination therapy of pegylated interferon α-2a plus ribavirin.