干扰素-α治疗慢性丙型肝炎的疗效预测模型

Efficacy prediction model of interferon-αtreatment for chronic hepatitis C

目的 评价普通干扰素-α联合利巴韦林治疗慢性丙型肝炎的疗效,探讨其影响因素并建立预测模型。方法 采用前瞻性队列研究,对句容市人民医院慢性丙型肝炎住院患者进行普通干扰素-α联合利巴韦林治疗48周并随访至治疗结束后24周,观察治疗不良反应及应答情况。采用Logistics回归分析其影响因素,并运用分类树建立预测模型。结果 216例慢性丙型肝炎患者完成了治疗周期及随访,其持续病毒学应答率（SVR）为61.2%。SVR组与非SVR组基线病毒载量、白蛋白、血小板计数、甲胎蛋白及血糖存在显著差异。多因素Logistics回归分析显示,基线病毒载量高（≥106IU/m L）者或血糖含量较高者更不易获得SVR。血小板计数较高者容易获得SVR（OR=1.02,95%CI=1.00~1.04）。SVR预测模型显示相对基线血小板计数低（〈140×109/L）者,血小板计数高者获得SVR的可能性增加17.9%。高血小板计数者中,基线HCV RNA低者（〈106IU/m L）更易获得SVR（79.7%︰57.9%）。治疗过程中不良反应有早期感冒样症状（51.9%）、胃肠道反应（14.8%）、血象的改变（58.8%）、血糖升高（18.1%）、精神症状（8.8%）、甲状腺功能亢进（1.4%）、皮疹（14.8%）、脱发（6.5%）。结论普通干扰素联合利巴韦林治疗慢性丙型肝炎疗效尚可,不良反应的程度较轻。基线病毒载量、血糖及血小板计数可能是丙型肝炎治疗效果的影响因素。

Objective To evaluate the curative effect of common interferon-α combined with ribavirin on the treatment of patients with chronic hepatitis C and to explore its influencing factors and establish the prediction model. Methods The patients with chronic hepatitis C were recruited from Jurong People＇s Hospital. Prospective cohort study was used, and all the patients were treated with common interferon-α for 48 weeks, and were followed up at 24 weeks to observe the rate of sustained virological response （SVR） and adverse reactions. Effect factors were studied by Logistic regression a- nalysis, and predication model was established by classification tree. Results Totally 216 patients completed the treatment and follow-up, and the SVR rate was 61.2%. There were significant differ- ences in baseline viral load, albumin, platelet count, AFP （alpha fetoprotein） and blood glucose be- tween SVR and non-SVR groups. Patients with higher baseline HCV RNA level （≥ 106 IU/mL） or blood glucose were less likely to get SVR. Patients with higher baseline platelet count （ 〈 140 × 109/L） were more likely to acquire SVR. The classification tree predication model of SVR showed that the probability of SVR increased by 17.9% in patients with higher baseline platelet count. In similar patients with high platelet count, those with lower baseline HCV RNA level （ 〈 106 IU/mL） were more likely to obtain SVR （ OR = 1.02, 95 % CI =- 1.00 - 1.04 ）. Common adverse reactions were early flu-like symptoms （51.9%）, gastrointestinal tract reaction （ 14.8% ）, hemogram changes （58.8%）, hyperglycemia （ 18.1% ）, psychiatric symptoms （8.8%）, hyperthyroidism （ 1.4% ）, rashes （ 14.8% ） and alopecia （6.5%）. Conclusion The baseline HCV RNA level, blood glu- cose and platelet count may be associated with SVR of chronic hepatitis C.