基因6型慢性丙型肝炎的流行病学特征及抗病毒疗效分析

Epidemiological features and antiviral response of genotype 6 chronic hepatitis C

目的分析广西地区基因6型慢性丙型肝炎(CHC)患者流行病学特点和抗病毒疗效。方法选取2012年12月—2020年12月在广西医科大学第一附属医院收治的97例基因6型CHC患者,其中62例经抗病毒治疗。62例患者分为干扰素治疗组(n=22)和直接抗病毒药物(DAA)治疗组(n=40)。收集患者的一般人口学资料及HCV RNA、肝功能、血常规、肾功能等指标。计数资料组间比较采用χ^(2)检验。结果97例患者中男69例(71.1%),女28例(28.9%),平均年龄(41.97±10.12)岁,30~40岁感染者居多,占47.4%(46/97)。基因6a型95例(97.9%),基因6e、6xa型各1例。静脉吸毒占明确感染途径患者的63.1%(41/65),医疗相关操作14例、输血相关9例及性接触4例。干扰素治疗组总体第4周获快速病毒学应答(RVR)率、停药时病毒检测不到(Epoint)率、停药后12周获持续病毒学应答(SVR12)率、停药后24周获持续病毒学应答(SVR24)率分别为81.8%(18/22)、86.4%(19/22)、81.8%、81.8%,其中1例出现复发。DAA治疗组40例均为初治患者(非肝硬化33例,代偿期肝硬化7例),总体RVR、Epoint、SVR12率分别为87.5%(35/40)、100%、100%,无治疗失败或复发者。各DAA方案虽RVR率不同,但SVR12率均为100%。代偿期肝硬化及合并其他疾病的患者SVR12率均达100%。结论广西地区基因6型CHC患者的感染途径主要以静脉药瘾为主,男性多见,亚型主要为6a型;DAA治疗相对于干扰素治疗有更高的病毒学应答率,SVR12率为100%;代偿期肝硬化与非肝硬化患者的SVR12率无差别。

Objective To investigate the epidemiological features and antiviral response of patients with genotype 6 chronic hepatitis C(CHC)in Guangxi,China.Methods A total of 97 patients with genotype 6 CHC who were admitted to The First Affiliated Hospital of Guangxi Medical University from December 2012 to December 2020 were enrolled,among whom 62 patients were given antiviral therapy.The 62 patients receiving antiviral therapy were divided into interferon group with 22 patients and direct-acting antiviral agent(DAA)group with 40 patients.Related data were collected,including general demographic data,HCV RNA,liver function,routine blood test results,and renal function.The chi-square test was used for comparison of categorical data between groups.Results Among the 97 patients,there were 69 male patients(71.1%)and 28 female patients(28.9%),with a mean age of 41.97±10.12 years,and the patients aged 30-40 years accounted for 47.4%(46/97).Of all 97 patients,95(97.9%)had genotype 6 a,1 had genotype 6 e,and 1 had genotype 6 xa.Among the 65 patients with a definite route of infection,41(63.1%)had intravenous drug use,14 had medical-related operations,9 had blood transfusion,and 4 had sexual contact as the route of infection.For the interferon group,the rapid virologic response(RVR)rate at week 4 was 81.8%(18/22),the rate of undetectable virus at the time of drug withdrawal(Epoint)was 86.4%(19/22),the rate of sustained virologic response at 12 weeks after drug withdrawal(SVR12)was 81.8%,and the rate of sustained virological response at 24 weeks after drug withdrawal(SVR24)was 81.8%;1 patient in this group experienced recurrence.All 40 patients in the DAA group were previously untreated patients(33 patients without liver cirrhosis and 7 patients with compensated liver cirrhosis),with an overall RVR rate of 87.5%(35/40),an Epoint rate of 100%,and an SVR12 rate of 100%,and there was no treatment failure or recurrence.Although different DAA regimens had different RVR rates,they all had a SVR12 rate of 100%.The patients with compensated liver cirrhosis and other diseases had a SVR12 rate of 100%.Conclusion Intravenous drug addiction is the main route of infection for patients with genotype 6 CHC in Guangxi,and CHC is more common in men,with genotype 6 a as the main subtype.DAA treatment has a higher virologic response rate than interferon treatment,with an SVR12 rate of 100%.There is no significant difference in SVR12 rate between the patients with compensated liver cirrhosis and those without liver cirrhosis.