抗病毒治疗的基因1b型慢性丙型肝炎患者疗效及其血清γ-干扰素和白细胞介素-10水平变化

Antiviral efficacy and serum interferon-γand interleukin-10 level changes in patients with chronic hepatitis C with genotype 1b infection

目的分析接受索磷布韦/达拉他韦或标准治疗方案治疗的基因1b型慢性丙型肝炎(CHC)患者疗效及其血清γ-干扰素(IFN-γ)和白细胞介素(IL)-10水平变化。方法2020年5月~2023年2月我院收治的基因1b型CHC患者58例,其中30例观察组接受索磷布韦/达拉他韦治疗,另28例接受聚乙二醇干扰素α-2a联合利巴韦林治疗,均持续治疗24 w。采用ELISA法检测血清IFN-γ和IL-10水平。结果在治疗结束时,观察组白细胞、血小板计数和血红蛋白水平分别为(5.5±1.2)×10^(9)/L、(116.2±19.5)×10^(9)/L和(121.5±19.7)g/L,均显著高于对照组【分别为(4.6±1.1)×10^(9)/L、(94.0±18.5)×10^(9)/L和(104.7±16.8)g/L,P<0.05】;观察组血清丙氨酸氨基转移酶和天冬氨酸氨基转移酶水平分别为(36.0±5.0)U/L和(38.2±5.5)U/L,显著低于对照组【分别为(47.5±5.8)U/L和(51.9±6.3)U/L,P<0.05】;观察组血清C-反应蛋白和IL-10水平分别为(13.4±1.8)ng/L和(36.5±14.6)pg/mL,均显著低于对照组【分别为(16.7±2.2)ng/L和(64.0±28.2)pg/mL,P<0.05】,而血清IFN-γ水平为(19.2±2.0)pg/mL,显著高于对照组【(10.4±2.2)pg/mL,P<0.05】;观察组快速病毒学应答、早期病毒学应答、治疗结束时病毒学应答和持续病毒学应答率分别为73.3%、90.0%、100.0%和96.7%),均显著高于对照组的42.8%、53.6%、71.4%和60.7%(P<0.05);在治疗4 w时,46例应答组血清IFN-γ水平为(23.5±4.7)pg/mL,显著高于12例未应答组【(8.5±1.7)pg/mL,P<0.05】,而血清IL-10水平为(29.0±13.2)pg/mL,显著低于未应答组【(84.5±30.1)pg/mL,P<0.05】。结论应用索磷布韦/达拉他韦治疗基因1b型CHC患者疗效好,病毒学应答率高,可能与成功诱发机体抗病毒免疫反应有关。

Objective The aim of this study was to observe the antiviral efficacy and serum interferon-γ(IFN-γ)and interleukin-10(IL)-10)level changes in patients with chronic hepatitis C(CHC)with genotype 1b infection.Methods 58 patients with CHC and genotype 1b infection were recruited in our hospital between May 2020 and February 2023,and the antiviral regimen by sorfosbuvir/daratavir was given in 30 patients in the observation group and by peginterferonα-2a and ribavirin combination was given in 28 patients in the control.The treatment lasted for 24 weeks in the two groups.Serum IFN-γand IL-10 levels were measured by ELISA.Results At the end of the antiviral treatment,the white blood cell count,platelet count and hemoglobin concentration in the observation group were(5.5±1.2)×10^(9)/L,(116.2±19.5)×10^(9)/L and(121.5±19.7)g/L,all significantly higher than[(4.6±1.1)×10^(9)/L,(94.0±18.5)×10^(9)/L and(104.7±16.8)g/L,respectively,P<0.05]in the control;serum ALT and AST levels in the observation group were(36.0±5.0)U/L and(38.2±5.5)U/L,both significantly lower than[(47.5±5.8)U/L and(51.9±6.3)U/L,P<0.05]in the control;serum CRP and IL-10 levels in the observation group were(13.4±1.8)ng/L and(36.5±14.6)pg/mL,both significantly lower than[(16.7±2.2)ng/L and(64.0±28.2)pg/mL,P<0.05],while serum IFN-γlevel was(19.2±2.0)pg/mL,significantly higher than[(10.4±2.2)pg/mL,P<0.05]in the control;the rapid virological response,early virological response,end-of-treatment response and sustained virological response in the observation group were 73.3%,90.0%,100.0%and 96.7%,all significantly higher than 42.8%,53.6%,71.4%and 60.7%(P<0.05)in the control group;at the end of four-week treatment,serum IFN-γlevel in 46 responders was(23.5±4.7)pg/mL,much higher than[(8.5±1.7)pg/mL,P<0.05],while serum IL-10 level was(29.0±13.2)pg/mL,much lower than[(84.5±30.1)pg/mL,P<0.05]in twelve non-responders.Conclusion The application of sorfosbuvir and daratavir in the treatment of patients with genotype 1b CHC has a good efficacy,which might be be related to the inhibition of viral replication and the successful induction of antiviral immunization.