单核苷酸多态性对接受直接抗病毒药物治疗慢性丙型肝炎患者疗效的预测价值

Efficacy of single nucleotide polymorphisms in predicting the outcomes in patients with chronic hepatitis C treated by direct-acting antivirals

目的探讨单核苷酸多态性对接受直接抗病毒药物(DAAs)治疗的慢性丙型肝炎(CHC)患者疗效的预测价值。方法前瞻性收集2020年6月至2022年6月宝鸡市中心医院收治的CHC患者112例,其中男64例,女48例,≥60岁41例,<60岁61例。所有患者均给予索磷布韦片,400 mg/次,1次/d,口服;盐酸达拉他韦片,60 mg/次,1次/d,口服。连续治疗12周。患者治疗结束后依据有无病毒学应答分为有应答组和无应答组。比较两组患者IL-28B基因多态性,分析CHC患者预后与临床特征的关系,采用多因素logistic回归分析确定CHC患者预后的影响因素。绘制受试者操作特征曲线(ROC)评估影响因素对患者预后的预测效能。结果112例CHC患者中89例(79.46%)存在病毒学应答,23例(20.54%)患者无应答。有应答组中rs8099917TT、rs12979860CC分别有79例(88.76%)、78例(87.64%),无应答组分别有10例(43.48%)、11例(47.83%),差异均有统计学意义(χ^(2)=22.969、17.754,均P<0.001);有应答组患者中无脂肪肝、Child肝功能分级A级分别有85例(95.51%)、35例(39.32%),无应答组分别有17例(73.91%)、6例(26.09%),差异均有统计学意义(均P<0.05)。多因素logistic回归分析结果显示,脂肪肝、Child肝功能分级C级、rs8099917TG、rs12979860CT均为CHC患者预后的影响因素(RR=4.513、3.666、2.998、3.575,均P<0.05)。ROC分析结果显示,脂肪肝、Child肝功能分级C级、rs8099917TG、rs12979860CT在预测CHC患者预后中具有极高价值。结论脂肪肝、Child肝功能分级C级、rs8099917TG、rs12979860CT均为CHC患者预后的影响因素,可根据以上指标指导临床治疗。

Objective To investigate the efficacy of single nucleotide polymorphisms in predicting the outcomes in patients with chronic hepatitis C(CHC)treated by direct-acting antivirals(DAAs).Methods A total of 112 patients with CHC admitted to Baoji Central Hospital from June 2020 to June 2022 were collected,including 64 males and 48 females,41 cases aged≥60 years and 61 cases aged<60 years.All patients were treated with DAAs for 6 months,and IL-28B gene polymorphism was detected before treatment.After treatment,the patients were divided into a response group and a non-response group according to whether there was a virologic response.The IL-28B gene polymorphism of the two groups was compared,and the relationships between prognosis and clinical features of CHC patients were analyzed.The influencing factors of prognosis in CHC patients were analyzed by multivariate logistic regression analysis.The receiver operator characteristic curve(ROC)was drawn to evaluate the predictive efficacies of influencing factors for patients'prognosis.Results Of the 112 CHC patients,89 patients(79.46%)had a virologic response and 23 patients(20.54%)had no response.There were 79 cases(88.76%)of rs8099917TT and 78 cases(87.64%)of rs12979860CC in the response group,and 10 cases(43.48%)and 11 cases(47.82%)in the non-response group,with statistically significant differences(χ^(2)=22.969 and 17.754,both P<0.001).There were 85 cases(95.51%)without fatty liver and 35 cases(39.32%)with Child liver function grade A in the response group,and 17 cases(73.91%)and 6 cases(26.09%)in the non-response group,with statistically significant differences(both P<0.05).Multivariate logistic regression analysis showed that fatty liver,Child liver function grade C,rs8099917TG,and rs12979860CT were all prognostic factors in CHC patients(RR=4.513,3.666,2.998,and 3.575,all P<0.05).ROC analysis results showed that fatty liver,Child liver function grade C,rs8099917TG,and rs12979860CT had high value in predicting the prognosis of CHC patients.Conclusion Fatty liver,Child liver function grade C,rs8099917TG,and rs12979860CT are all prognostic factors of CHC patients,and we can guide clinical treatment according to the above indicators.