难治性慢性丙型肝炎强化治疗疗效研究

目的探讨难治性慢性丙型肝炎强化治疗疗效，通过优化治疗剂量和疗程来提高慢性丙型肝炎患者对干扰素联合利巴韦林治疗的持续病毒应答率。方法对常规治疗的干扰素剂量（聚乙二醇干扰素α每周皮下注射1次）和利巴韦林（每天10．5mg／kg）经治的无应答和部分患者，根据患者的意愿进行标准干扰素α10 MU隔日注射1次或聚乙二醇干扰素α-2a（PEG—IFN α-2a）360μg每周注射1次，并根据体重每天给予15mg／kg的利巴韦林的强化剂量治疗，在治疗的0、4、12周和以后的每间隔12周、治疗结束后的24周进行HCV RNA含量检测，根据患者治疗过程中的病毒应答情况给予72～96周的疗程，以持续病毒应答（sustained viral response，SVR）作为疗效的评判指标。结果18例患者完成全程治疗和观察，12例获得持续病毒学应答，5例治疗无效，1例复发。3例患者获得RVR，RVR获得者的cEVR和SVR均为3／3，RVR组治疗前的病毒载量显著低于未获得RVR组（t=4．687，P〈0．001）。15例无快速病毒应答者，8例获得完全早期病毒应答，9例获得SVR。聚乙二醇干扰素α-2a 360μg每周注射1次的SVR为4／5。11例获得cEVR患者均获得SVR，7例无cEVR的患者，仅1例获得SVR。结论强化剂量的干扰素和RBV可以使较高比例的既往规范抗病毒治疗无应答、部分应答获得SVR。在强化治疗过程中根据病毒的应答情况及时调整和延长HCV RNA阴性的疗程是提高难治性慢性丙型肝炎持续病毒应答率的重要措施。

Study on effect of intensive treatment for refractory chronic hepatitis C patients

Objective To explore the effect of intensive treatment for refractory chronic hepatitis C, and to improve the sustained viral response （SVR） rate of treatment with interferon plus ribavirin by optimizing therapeutic dose and course. Methods Patients who did not acquire response or partial response by standard therapy （PEG-IFN α subcutaneous injection weekly plus Ribavirin 10.5 mg/kg） every day were enrolled and retreated with intensive treatment of 10 MU interferon every other day or 360 μg pegylated interferon α-2a weekly according to patients＇ wishes, and ribavirin 15 mg/kg every day. Serum HCV RNA was detected at baseline,treatment week 4,12 and every 12 weeks suceedent and 24 weeks after treatment end. Course of treatment was 72 to 96 weeks aecording to viral response. SVR was the mark of therapeutic effeet. Results 18 patients eompleted whole range therapy and follow-up, in whieh 12 patients acquired SVR,5 patients treatment failure and 1 relapse. 3 patients aequired rapid viral response（ RVR）, and they all got complete Early Viral Response （cEVR） and SVR. RVR Patients＇ viral loads were significantly lower than that of patients who did not acquire RVR（ t = 4. 687 ,P 〈 0. 001 ）. In 15 patients who did not aequire RVR, 8 patients acquired cEVR, and 9 acquired SVR. SVR rate of patients who were administered PEG- IFN α-2a was 4/5, 11 patients who acquired cEVR all acquired SVR, while in 7 patients who did not aequire cEVR, only 1 patient acquired SVR. Conclusions High percent patients, who did not acquire response or partial response by previous standard antiviral therapy, could gain SVR by intensive dose interferon plus Ribavirin. In intensive treatment procedure, adjusting and prolonging course according to viral response after HCV RNA turned negative were important measures to improve refractory Chronic Hepatitis C SVR rate.