长效干扰素联合利巴韦林治疗慢性丙型肝炎患者疗效及其对静息能量消耗和营养状态的影响

Peginterferon-αand ribavirin combination in treatment of patients with chronic hepatitis C and its impact on resting energy expenditure and nutritional status

目的探讨应用长效α-干扰素联合利巴韦林治疗慢性丙型肝炎(CHC)患者疗效及静息能量消耗和营养状态的变化。方法2017年4月~2019年4月我院收治的CHC患者48例,采用随机数字表法分为观察组24例和对照组24例,分别给予聚乙二醇干扰素α-2a(peg-IFNα-2a)和利巴韦林治疗或干扰素α-2a(IFNα-2a)联合利巴韦林治疗48 w。测量静息能量消耗(REE)和预测静息能量消耗(pREE),常规检测血清前白蛋白(PA)和白蛋白(ALB)水平,计算体质指数(BMI)。结果在治疗48 w结束和随访6 m时,观察组完全应答率分别为62.5%和54.2%,显著高于对照组的37.5%和29.2%,差异有统计学意义(P<0.05);在观察组,用药前REE和pREE分别为(1504.6±481.5)kcal/d和(1432.3±229.3)kcal/d,在治疗结束时显著增加至(1822.1±546.7)kcal/d和(1241.8±208.6)kcal/d,对照组用药前REE和pREE分别为(1505.2±482.1)kcal/d和(1433.5±231.2)kcal/d,在治疗结束时,显著增加至(1824.4±547.6)kcal/d和(1243.1±208.8)kcal/d,但两组之间REE和pREE变化无显著性差异(P>0.05);治疗前,观察组BMI及血清PA和ALB水平分别为(19.2±2.0)kg/m^(2)、(161.5±45.2)mg/L和(38.4±4.2)g/L,在治疗结束时分别降为(17.1±1.5)kg/m^(2)、(135.8±40.2)mg/L和(34.2±3.2)g/L,治疗前对照组BMI及血清PA和ALB水平分别为(19.3±2.1)kg/m^(2)、(161.3±45.0)mg/L和(38.5±4.4)g/L,在治疗结束时分别降为(17.2±1.5)kg/m^(2)、(136.3±40.2)mg/L和(34.2±3.1)g/L,但两组之间这些指标的变化无显著性差异(P>0.05)。结论相对于IFNα-2a与利巴韦林联合,应用peg-IFNα-2a与利巴韦林联合治疗CHC患者能够获得更好的治疗效果,但无论何种治疗方案,均增加了能量消耗,降低了体质量和血清白蛋白水平,提示标准方案抗病毒治疗的不良反应还是值得重视的。

Objective The aim of this clinical trial was to investigate the response of peginterferon-α-2a(PEG-IFNα-2a)and ribavirin combination in treatment of patients with chronic hepatitis C and its impact on resting energy expenditure(REE)and nutritional status.Methods Forty-eight patients with CHC were enrolled in this clinical trial between April 2017 and April 2019,and were randomly divided into observation and control group,with 24 cases in each group.The patients in the observation group were treated with PEG-IFNα-2a and ribavirin,and those in the control group were treated with interferonα-2a(IFNα-2a)and ribavirin combination for 48 weeks.The REE,predicted REE(pREE)as well as body mass index(BMI)and serum prealbumin(PA)and albumin(ALB)levels were obtained.Results At the end of 48 week treatment and 6 month of followed-up,the complete response in the observation group were 62.5%and 54.2%,both significantly higher than 37.5%and 29.2%in the control(P<0.05);at presentation,the REE and pREE in the observation were(1504.6±481.5)kcal/d and(1432.3±229.3)kcal/d,both increased to(1822.1±546.7)kcal/d and(1241.8±208.6)kcal/d at the end of the treatment,and they were(1505.2±482.1)kcal/d and(1433.5±231.2)kcal/d in the control before treatment,and they also increased to(1824.4±547.6)kcal/d and(1243.1±208.8)kcal/d at the end of the regimen,not significantly different between the two groups(P>0.05);before treatment,the BMI,serum PA and ALB levels in the observation were(19.2±2.0)kg/m^(2),(161.5±45.2)mg/L and(38.4±4.2)g/L,they decreased to(17.1±1.5)kg/m^(2),(135.8±40.2)mg/L and(34.2±3.2)g/L at the end of the treatment,and those in the control before treatment were(19.3±2.1)kg/m^(2),(161.3±45.0)mg/L and(38.5±4.4)g/L,and all decreased to(17.2±1.5)kg/m^(2),(136.3±40.2)mg/L and(34.2±3.1)g/L at the end of the treatment,without significant differences between the two groups(P>0.05).Conclusion Compared with IFNα-2a and ribavirin combination,the application of PEG-IFNα-2a and ribavirin in treatment of patients with CHC could achieve a better virological response,while no matter IFNα-2a or PEG-IFNα-2a might increase resting energy expenditure and induce malnutrition,which warrants clinical attentions.