肾功能衰竭合并丙型肝炎行血液透析患者的抗病毒治疗临床分析

Clinical analysis of antiviral therapy on patients with renal failure complicated with hepatitis C treated by hemodialysis

目的观察肾功能衰竭(chronic renal failure,CRF)合并慢性丙型肝炎(chronic hepatitis C,CHC)行血液透析(hemodialysis,HD)患者采用干扰素(interferon,IFN)联合利巴韦林(Ribavirin,RBV)抗病毒治疗临床疗效及影响因素。方法对19例CHC合并CRF并行HD患者采用IFN联合RBV进行抗病毒治疗,对其临床资料(体质量指数、肝功能、基线HCV RNA载量、基因型、IL28基因分型等)进行总结,对快速病毒学应答(RVR)、早期病毒学应答(EVR)、持续病毒学应答(SVR)及其治疗过程中不良反应进行分析。结果 19例患者中,获得RVR 9例(47.4%),获得EVR 16例(84.2%),获得SVR 16例(84.2%);基因1型获得SVR 13例(68.4%),非基因1型获得SVR 3例(15.8%)。HCV RNA非高病毒载量8例(42.1%),均获得SVR。IL28B rs12979860位点基因型为CC、CT、TT各17、2、0例,基因1型患者rs12979860 CC型共14例(73.7%),13例(68.4%)获得SVR。1例(5.3%)因严重贫血停用RBV,1例(5.3%)因不能耐受药物不良反应终止治疗。结论 IFN联合RBV抗病毒治疗CRF合并CHC行HD患者治疗效果好,且基因1型非高载量的、宿主基因IL28b CC型能达到较高的SVR率。患者不良反应能够耐受。

Objective To observe the clinical efficacy and influence factors of interferon （IFN） combined with Ribavirin （RBV） in hemodialysis （HD） patients who sufferred from chronic renal failure （CRF） accompanied by chronic hepatitis C （CHC）. Methods Nineteen HD patients with CRF and CHC were treated with a combination of the drug IFN and RBV. The clinical data, including body mass index, liver function, the baseline of HCV RNA load, HCV genotypes （GTs） and IL28 genotype were collected and summarized while RVR, EVR, SVR and adverse drug effects in the course of treatment were detected and analyzed. Results Among the 19 patients, RVR were obtained in 9 cases （47.4%） , while EVR and SVR were obtained in 16 cases （84.2%） ; SVR in 13 cases （68.4%） were obtained in GT-1 infected patients while SVR in 3 cases （15.8%） were obtained in non-GT-1 patients. The rate of SVR in 8 cases （42.1%） whose HCV RNA load were not high was 100%. The SVR rate in patients with rs12979860 of IL28B genotype were CC （17 cases） , CT （2 cases） , TT （0 case） , respectively. 13 cases in the 14 GT-1 cases （73.7%） whose IL28B genotype were rs12979860 CC got a SVR, with the rate of 68.4%. One patient （5.3%） discontinued RBV due to severe anemia, and 1 case （5.3%） terminated the treatment for poor tolerance of adverse drug effects. Conclusion The antiviral therapy on HD patients with CRF with CHC has a good efficacy. The SVR rate is higher in GT-1 infected paients with non-high viral load and IL28b CC of host genetype. The patient＇s adverse reaction can be tolerated.