复发和无应答慢性丙型肝炎患者再治疗的临床疗效分析

目的观察既往治疗后复发和无应答的慢性丙型肝炎患者再治疗的疗效,并分析可能影响疗效的因素。方法采用开放性、前瞻性队列研究。入组复发无应答患者,给予聚乙二醇干扰素（PEG-IFN）α-2a 180μg/周联合利巴韦林10.6～15 mg.kg-1.d-1治疗。无应答组27例,疗程为72周;复发组18例,疗程为48周;动态留取血清,进行血常规、肝功能和HCV RNA的检测,以分析疗效及相关影响因素。结果复发组和无应答组患者快速病毒学应答（RVR）分别为55.6%和25.9%（P=0.045）,完全早期病毒学应答（cEVR）分别为83.3%和51.9%（P=0.031）,治疗结束时病毒学应答率（ETVR）分别为83.3%和59.3%（P=0.087）。基线HCVRNA在复发组低于无应答组,同时获得病毒学应答组（RVR、cEVR、ETVR）基线HCV RNA也均低于未获得病毒学应答组（仅cEVR节点有统计学意义,P=0.039）;复发组病毒动力学呈快速下降,无应答组病毒动力学呈缓慢下降;获得病毒学应答（RVR、cEVR、ETVR）组基线淋巴细胞百分比（LYPH%）均高于未获得病毒学应答组（P=0.009、0.037、0.020）。结论复发和无应答慢性丙型肝炎患者再治疗后,复发组近期疗效（RVR、cEVR、ETVR）优于无应答组;基线HCV RNA低、病毒动力学快速下降型及基线较高水平LYPH%是疗效的阳性预测因素。

Clinical effect of pegylated interferon in combination with ribavirin in the retreatment of previous nonresponders or relapsers of chronic hepatitis C

Objective To evaluate the effect of pegylated interferon in combination with Ribavirin in previous nonresponders or relapsers of chronic hepatitis C ,and to analyze the factors that may affect the efficacy of treatment. Methods This is an open, prospective cohort study. The nonresponders and relapsers were treated with PEG -IFN α -2a 180 μg/w and Ribavirin 10. 6 -15 mg . kg- 1 . d -1. The course of treatment of 27 nonresponders was 72 weeks, and that of 18 relapsers was 48 weeks. The blood samples were kept for the detection of blood routine analysis, liver function and HCV RNA to find the relation between Virological response and baseline. Results RVR in relapsers and nonresponders were 55.6% vs 25.9% （P = 0.045 ）, eEVR were 83.3% vs 51.9% （P = 0.031 ）, and ETVR were 83.3% vs 59.3 % （P = 0.087 ）. Baseline HCV RNA in relapsers is lower than in nonresponders ,as well as in group of RVR, cEVR and ETVR（ but there was statistical significance only in cEVR, P = 0. 039）. Viral dynamics in relapsers decline rapidly while in nonresponders slowly. LYPH% in the virologic response（ RVR, cEVR and ETVR） are higher than in the non - virologic response at baseline. （P =0.009,0.037,0.020） Conclusion The re -treatment effect （RVR,cEVR,ETVR） on previous relapsers are better than that of previous nonresponders. Those that the slowly HCV RNA viral load and rapid decline in viral dynamics model and higher the level of LYPH% are all the positive predictors of efficacy.