聚乙二醇干扰素α-2b联合利巴韦林治疗不同发病时间急性丙型肝炎的疗效评价

doi:10.3969/j.issn.1673-8640.2015.10.002

摘要/Abstract

摘要： 目的

探讨治疗时机对聚乙二醇干扰素α-2b(PEG-IFNα-2b)联合利巴韦林治疗急性丙型肝炎(AHC)疗效的影响。

方法

将40例AHC患者按发病时间分为Ⅰ组(病毒血症持续3个月以内)23例、Ⅱ组(病毒血症持续3至6个月)17例,应用PEG-IFNα-2b(80 μg/周)联合利巴韦林(800 mg/d)治疗24周。于治疗前(第0周)及治疗后第12、24、48周检测血清丙型肝炎病毒(HCV)RNA、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、透明质酸(HA)及层黏连蛋白(LN)的水平,并对所得数据进行统计学分析。

结果

Ⅰ组和Ⅱ组在治疗前HCV RNA、ALT、AST、HA、LN水平差异有统计学意义(P<0.05)。治疗后Ⅰ组HCV RNA载量和ALT、AST、HA、LN水平均下降,与治疗前及Ⅱ组治疗后比较,差异有统计学意义(P<0.05)。治疗后Ⅰ组的早期病毒学应答(EVR)率、治疗结束时病毒学应答(ETVR)率、持久病毒学应答(SVR)率、生化学应答(BR)率和HA、LN的复常率均明显高于Ⅱ组治疗后(P均<0.05),治疗后Ⅱ组的复发率明显高于Ⅰ组治疗后(P<0.05)。

结论

PEG-IFNα-2b联合利巴韦林治疗AHC能在一定程度上阻止其慢性化及肝纤维化,病毒血症持续3个月以内的AHC患者用上述方案治疗效果显著好于病毒血症持续3至6个月的患者。病毒血症持续3至6个月的AHC患者治疗后病情容易复发。

关键词: 聚乙二醇干扰素α-2b, 利巴韦林, 治疗时机, 疗效, 急性丙型肝炎

Abstract: Objective

To investigate the efficacy influence of polyethylene glycol interferon alpha-2b(PEG-IFNα-2b)plus ribavirin treatment for acute hepatitis C(AHC) in different times.

Methods

All 40 patients with AHC were classified into Ⅰ(viremia lasted less than 3 months, 23 cases) and Ⅱ(viremia lasted for 3 months to 6 months, 17 cases) groups, and they were administrated PEG-IFNα-2b (80 μg/week) combined with ribavirin (800mg/d) for 24 weeks. Before the treatment(at the end of week 0) and after the treatment (at the ends of week 12, 24 and 48), serum hepatitis C virus (HCV) RNA, alanine aminotransferase (ALT), aspartate aminotransferase (AST), hyaluronic acid (HA) and laminin (LN) were determined. The results were analyzed statistically.

Results

The HCV RNA, ALT, AST, HA and LN before the treatment in Ⅰ and Ⅱ groups were different statistically(P<0.05). After the treatment, the levels of HCV RNA, ALT, AST, HA and LN in Ⅰ group decreased. Compared with those before the treatment of Ⅰ group and after the treatment of Ⅱ group, there was statistical significance (P<0.05). After the treatment, the early virological response(EVR)rate and virological response at end of therapy(ETVR) rate, sustained virological response(SVR)rate, biochemical response(BR) rate and the recovery rates of HA and LN of Ⅰ group were higher than those after the treatment of Ⅱ group (P<0.05). The relapse rate in Ⅱ group after the treatment was higher than that in Ⅰ group after the treatment(P<0.05).

Conclusions

The PEG-IFNα-2b plus ribavirin treatment for AHC could prevent the occurrence of chronic hepatitis C and liver fibrosis. The clinical curative efficacy of AHC with viremia lasted less than 3 months with this therapeutic schedule is better than that with viremia lasted for 3 months to 6 months. It is easy to relapse in AHC patients with viremia lasted for 3 months to 6 months after the treatment.

Key words: Polyethylene glycol interferon alpha-2b, Ribavirin, Treatment time, Curative efficacy, Acute hepatitis C

中图分类号:

R446.61

赵华, 金航芸, 潘统桧, 方玉才. 聚乙二醇干扰素α-2b联合利巴韦林治疗不同发病时间急性丙型肝炎的疗效评价[J]. 检验医学, 2015, 30(10): 975-979.

ZHAO Hua, JIN Hangyun, PAN Tonghui, FANG Yucai. Evaluation on the efficacy of PEG-IFNα-2b plus ribavirin treatment for acute hepatitis C in different times[J]. Laboratory Medicine, 2015, 30(10): 975-979.

图/表 3

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组别	例数	HCV载量 (lg HCV RNA 拷贝/mL)	ALT(U/L)		AST (U/L)		HA (ng/mL)	LN (ng/mL)
Ⅰ组	23
第0周		5.8±0.3	80	±20	83	±6	150.3±60.3	80.3±10.8
第12周		2.9±0.0^**	40	±8^*	46	±3^*	90.1±18.3^*	60.1±15.9^*
第24周		2.9±0.0^**	28	±6^*	23	±8^*	50.1±10.2^*	30.2±8.1^*
第48周		2.9±0.0^**	16	±3^**	11	±4^**	27.2±2.6^**	13.2±6.1^**
Ⅱ组	17
第0周		6.3±1.3^△	150	±31^△	180	±20^△	220.1±80.3^△	100.5±20.3^△
第12周		3.6±1.6^*#	63	±12^*#	70	±6^*#	120.2±60.1^*#	70.9±10.5^*#
第24周		2.9±0.1^**#	45	±6^**#	48	±6^**#	92.1±20.1^*#	60.3±10.8^*#
第48周		3.0±0.3^**#	43	±9^**##	41	±5^**##	88.5±20.6^**##	40.8±8.7^**##

组别	例数	HCV载量 (lg HCV RNA 拷贝/mL)	ALT(U/L)		AST (U/L)		HA (ng/mL)	LN (ng/mL)
Ⅰ组	23
第0周		5.8±0.3	80	±20	83	±6	150.3±60.3	80.3±10.8
第12周		2.9±0.0^**	40	±8^*	46	±3^*	90.1±18.3^*	60.1±15.9^*
第24周		2.9±0.0^**	28	±6^*	23	±8^*	50.1±10.2^*	30.2±8.1^*
第48周		2.9±0.0^**	16	±3^**	11	±4^**	27.2±2.6^**	13.2±6.1^**
Ⅱ组	17
第0周		6.3±1.3^△	150	±31^△	180	±20^△	220.1±80.3^△	100.5±20.3^△
第12周		3.6±1.6^*#	63	±12^*#	70	±6^*#	120.2±60.1^*#	70.9±10.5^*#
第24周		2.9±0.1^**#	45	±6^**#	48	±6^**#	92.1±20.1^*#	60.3±10.8^*#
第48周		3.0±0.3^**#	43	±9^**##	41	±5^**##	88.5±20.6^**##	40.8±8.7^**##

组别	例数	EVR率	ETVR率	SVR率	复发率
Ⅰ组	23	100.0(23)	100.0(23)	100.0(23)	0.0(0)
Ⅱ组	17	52.9(9)^*	88.2(15)^*	76.5(13)^*	11.8(2)^**

组别	例数	EVR率	ETVR率	SVR率	复发率
Ⅰ组	23	100.0(23)	100.0(23)	100.0(23)	0.0(0)
Ⅱ组	17	52.9(9)^*	88.2(15)^*	76.5(13)^*	11.8(2)^**

组别	例数	BR率	HA复常率	LN复常率
Ⅰ组	23
第0周		0.0(0)	0.0(0)	0.0(0)
第12周		95.7(22)^*	91.3(21)^*	91.3(21)^*
第24周		100.0(23)^*	100.0(23)^*	100.0(23)^*
第48周		100.0(23)^*	100.0(23)^*	100.0(23)^*
Ⅱ组	17
第0周		0.0(0)	0.0(0)	0.0(0)
第12周		47.1(8)^*#	52.9(9)^*#	47.1(8)^*#
第24周		82.4(14)^*#	70.5(12)^*#	76.5(13)^*#
第48周		88.2(15)^*#	82.4(14)^*#	70.5(12)^*#