干扰素联合利巴韦林治疗慢性丙型肝炎的疗效观察

目的观察干扰素联合利巴韦林治疗慢性丙型肝炎的临床效果。方法选择我院2008年1月—2011年6月收治的慢性丙型肝炎患者72例,随机分为观察组和对照组,每组36例,对照组单独应用聚乙二醇干扰素α-2a(Peg-IFNα-2a),观察组在应用Peg-IFNα-2a同时口服利巴韦林1200mg/d。结果治疗结束后24周进行疗效评价,观察组持续应答明显高于对照组,差异有统计学意义(P<0.05)。结论聚乙二醇干扰素联合利巴韦林治疗慢性丙型肝炎效果较好,值得在临床推广。     

聚乙二醇干扰素联合利巴韦林治疗慢性丙型肝炎疗效观察

目的:观察聚乙二醇干扰素(PEG-IFNα-2a)联合利巴韦林治疗慢性丙型肝炎的临床疗效.方法:将53例慢性丙型肝炎患者随机分为2组,试验组28例给予PEG-IFNα-2a和利巴韦林治疗,对照组25例给予普通干扰素和利巴韦林治疗,疗程均为48周.随访24周,比较2组病毒学及生化应答情况.结果:与对照组相比,试验组患者病毒学应答率明显升高,治疗结束病毒学应答(ETVR)和持续病毒学应答(5VR)率比较差异有统计学意义(P<0.05).与治疗前相比,2组肝功能均明显改善;疗程结束及随访24周时,试验组仍保持较高的生化应答率(P<0.05).结论:PEG-IFNα-2a联合利巴韦林治疗慢性丙型肝炎具有良好的病毒应答和生化应答,疗效优于普通干扰素.     

聚乙二醇干扰素联合利巴韦林治疗慢性丙型肝炎疗效观察

目的观察聚乙二醇干扰素(PEG-IFNα-2a)联合利巴韦林治疗慢性丙型肝炎的临床疗效。方法将53例慢性丙型肝炎患者随机分为2组,试验组28例给予PEG-IFNα-2a和利巴韦林治疗,对照组25例给予普通干扰素和利巴韦林治疗,疗程均为48周。随访24周,比较2组病毒学及生化应答情况。结果与对照组相比,试验组患者病毒学应答率明显升高,治疗结束病毒学应答(ETVR)和持续病毒学应答(SVR)率比较差异有统计学意义(P<0.05)。与治疗前相比,2组肝功能均明显改善;疗程结束及随访24周时,试验组仍保持较高的生化应答率(P<0.05)。结论 PEG-IFNα-2a联合利巴韦林治疗慢性丙型肝炎具有良好的病毒应答和生化应答,疗效优于普通干扰素。     

α-2b干扰素联合利巴韦林治疗丙型肝炎的临床疗效观察

目的 探讨α-2b干扰素联合利巴韦林治疗丙型肝炎患者的具体方法与临床疗效.方法 选择2011-2012年入住我院接受常规治疗的641例丙型肝炎患者,患者均给予α-2b干扰素联合利巴韦林治疗,治疗疗程为12个月.疗程结束并出院后进行6～12个月的病情观察随访.最后总结两种药物联合使用对丙型肝炎的主要影响.结果 641例患者中,急性和慢性丙型肝炎分别有32例和568例,丙型肝炎硬化为41例.治疗后三类丙型肝炎患者治疗时的ETR和稳定后的SR情况：急性患者ETR 27例 （84.4%）和SR 25例（81.3%）,慢性患者ETR 402例（70.7%）,SR376例（67.9%）;肝硬化患者ETR 24例（58.5%）和SR 17例（41.5%）.在急慢性患者中,1个月内可应答的患者相比于1个月后才应答患者的复发率要低,差异有统计学意义（P＜0.05）.治疗后1个月内有应答ETR的患者有375例（58.5%）,患者出现HCV RNA转阴和ALT恢复正常.375例患者中,急性丙型肝炎患者有20例（53.3%）.慢性丙型肝炎患者有322例（85.9%）.丙型肝硬化患者33例（8.8%）.对患者进行为期6～12个月的随访中无1例患者出现HCV RNA转阳复发现象.治疗1个月之后有应答的140例ETR例患者中,急性、慢性以及肝硬化患者分别有有40、85和15例.出现复发现象分别有20、48和5例.可见,采用α-2b联合利巴韦林治疗丙型肝炎1个月内出现应答的ETR患者疾病复发率相对比较低,而1个月后出现应答的ETR患者疾病复发率则相对比较高,两者对比差异有统计学意义（P＜0.05）.α-2b干扰素的不良反应主要以肌肉酸痛、发热以及轻微脱发等为主.本研究641例患者治疗期间有186例出现发热和血小板减少等症状,但是并没有影响整个疗程,给予降温等治疗后均恢复正常.利巴韦林治疗时有30例患者出现较严重的食欲不振症状.皮疹132例,甲状腺功能异常13例,精神症状2例.但是在停药后均全部自行恢复.结论 α-2b干扰素联合利巴韦林治疗丙型肝炎效果较为显著,但相比于远期效果而言,其近期效果更为显著,值得在临床上推广和使用.     

聚乙二醇干扰素α-2a治疗慢性丙型肝炎68例临床观察

目的观察聚乙二醇干扰素α-2a治疗慢性丙型肝炎的疗效。方法选择采用聚乙二醇干扰素α-2a治疗的慢性丙型肝炎患者68例作为观察组,同时选择同期采用普通干扰素α-2a治疗的60例慢性丙型肝炎患者作为对照组。所有患者均治疗1年,治疗结束后随访3～6个月,观察2组患者治疗前与治疗后病毒应答及生物化学应答情况。结果观察组早期病毒应答(EVR)、完全应答(ETVR)、持续应答(SVR)率均高于对照组,差异有统计学意义(P<0.05)。观察组治疗3个月、随访3个月生物化学应答率高于对照组,复发率明显低于对照组,差异均有统计学意义(P<0.05)。结论聚乙二醇干扰素α-2a可长时间维持有效血药浓度,并可长时间持续抑制病毒的复制,值得临床推广应用。     

重组人干扰素α-1b联合利巴韦林片治疗慢性丙型肝炎的疗效及安全性评价

目的 评价重组人干扰素α-1b联合利巴韦林片治疗慢性丙型肝炎患者的疗效及安全性.方法 选择2010年1月-2013年6月在我院就诊的慢性丙型肝炎患者120例,将患者随机分成对照组和观察组.对照组给予重组人干扰素α-2b注射液治疗,观察组给予重组人干扰素α-1b联合利巴韦林片治疗.观察两组患者的肝功能和药物不良反应.结果 治疗48周时,观察组HCV-RNA转阴率、ALT复常率均高于对照组,差异有统计学意义（P＜0.05）.治疗期间,两组患者不良反应比较,差异均无统计学意义（P＞0.05）.结论 重组人干扰素α-1b联合利巴韦林片治疗慢性丙型肝炎患者疗效佳,具有良好的安全性.     

派罗欣联合利巴韦林治疗慢性丙肝的临床价值分析

目的 探讨聚乙二醇干扰素α-2a注射液(商品名：派罗欣)联合利巴韦林在慢性丙型肝炎(丙肝)患者治疗中的价值。方法 76例慢性丙肝患者,采用随机数字表法分为对照组和观察组,每组38例。对照组患者采用干扰素联合利巴韦林治疗,观察组患者采用派罗欣联合利巴韦林治疗。对比两组患者临床疗效,治疗前后丙氨酸氨基转移酶(ALT)、谷草转氨酶(AST)水平,药物不良反应发生情况。结果 观察组的治疗总有效率为97.37%,高于对照组的84.21%,差异具有统计学意义(P<0.05)。治疗前,两组ALT、AST水平对比差异均无统计学意义(P>0.05);治疗后,观察组患者的ALT(39.29±8.16)U/L、AST(35.25±2.37)U/L均低于对照组的(45.79±9.16)、(42.59±3.16)U/L,差异具有统计学意义(P<0.05)。观察组患者的药物不良反应发生率为10.53%,与对照组的15.79%对比,差异无统计学意义(P>0.05)。结论 慢性丙肝患者采用派罗欣联合利巴韦林治疗能够获得满意的临床疗效,并可有效改善患者的肝功能,同时该药物方案的安全性良好。     

两种聚乙二醇干扰素分别联合利巴韦林治疗丙型病毒性肝炎疗效分析

目的探讨聚乙二醇α-2a干扰素联合利巴韦林及聚乙二醇α-2b干扰素联合利巴韦林治疗丙型肝炎的疗效。方法选取本院收治的丙型肝炎病例120例,分为派罗欣组及佩乐能组,每组60例,派罗新组给予聚乙二醇α-2a干扰素联合利巴韦林治疗,佩乐能组给予聚乙二醇α-2b干扰素联合利巴韦林治疗,对两组患者病毒学应答及副作用进行统计分析。结果派罗欣组患者RVR率71.67%,EVR率91.67%,SVR率91.67%,流感样症状83.33%,腹泻21.67%,粒细胞下降68.33%,脱发11.67%,甲状腺功能异常18.33%。佩乐能组患者RVR率73.33%,EVR率90.00%,SVR率90.00%,流感样症状68.33%,腹泻23.33%,粒细胞下降66.7%,脱发13.33%,甲状腺功能异常16.67%。两组患者RVR、EVR、SVR率无统计学差异,而流感样症状佩乐能相对较少,差异有统计学意义(P<0.05),腹泻、粒细胞下降、脱发及甲状腺功能异常,差异无统计学意义(P>0.05)。结论派罗欣及佩乐能联合利巴韦林治疗丙型肝炎疗效等同。目前两种长效干扰素分别联合利巴韦林仍然可以作为丙型肝炎治疗的首选方法之一。     

聚乙二醇干扰素α-2a联合利巴韦林治疗代偿期丙肝后肝硬化的临床体会

目的分析研究聚乙二醇干扰素α-2a联合利巴韦林治疗代偿期丙型肝炎(丙肝)后肝硬化的临床效果。方法随机数字抽样选取我院收治的33例慢性丙肝后肝硬化患者为肝硬化组,以及同期接受治疗的33例慢性丙型肝炎患者为肝炎组,均给予患者采用聚乙二醇干扰素α-2a联合利巴韦林治疗,比较两组患者病毒学应答率以及不良反应情况。结果两组RVR、EVR、ETVR比较无明显差异,SVR比较差异显著,肝硬化组的骨髓抑制以及贫血发生率明显高于肝炎组,P<0.05比较差异有统计学意义。结论代偿期丙肝后肝硬化患者,采用聚乙二醇干扰素α-2a联合利巴韦林治疗,其早期应答效果良好,治疗效果显著。     

聚乙二醇干扰素α-2a与普通干扰素α-2a联合利巴韦林治疗慢性丙型肝炎50例疗效观察

目的 观察长效干扰素与普通干扰素治疗慢性丙型肝炎的临床疗效和安全性.方法 将我院感染科自2009年1月至2011年1月收治的慢性丙肝100例随机分成治疗组50例,对照组50例.治疗组给予聚乙二醇干扰素α-2a 180μg,每周1次,皮下注射;对照组给予普通干扰素α-2a500万单位,隔日1次,肌内注射.两组均联合利巴韦林片(体重＞ 85 kg者1200 mg/d,65 ～85 kg者1000 mg/d,＜65kg者800mg/d),疗程48周.观察两组的病毒学应答,评价疗效和不良反应的发生情况.结果 治疗组在快速病毒学应答(RVR)、早期病毒学应答(EVR)、治疗结束时病毒学应答(ETVR)、持续病毒学应答(SVR)、无应答及复发率上均明显优于对照组(P＜0.05).结论 聚乙二醇干扰素α-2a联合利巴韦林治疗慢性丙型肝炎优于普通干扰素联合利巴韦林.     

干扰素联合利巴韦林治疗慢性丙型肝炎的疗效观察

目的 探讨干扰素联合利巴韦林治疗慢性丙型肝炎(chronic hepatitis C,CHC)的临床疗效及对肝功能和肝纤维化指标的影响.方法 将滨州市人民医院2011年3月～2012年3月收治的88例CHC患者按照随机数字表法分为2组,每组44例.对照组单用干扰素治疗,观察组采用干扰素联合利巴韦林治疗,比较治疗后2组临床疗效和治疗前后2组肝功能和肝纤维化指标变化情况.结果 观察组治疗总有效率为90.91％,明显高于对照组的68.18％,2组比较差异具有统计学意义(P＜0.05);观察组治疗后ALT和AST分别为(70.24±7.94) U/L和(79.45±9.72) U/L,HA、PCⅢ、CⅣ和LN分别为(76.87±10.32) μg/L、(79.45±9.72) μg/L、(79.76±8.00) μg/L和(118.41±16.97) μg/L,均明显高于治疗前和对照组,差异具有统计学意义(P＜0.05).结论 干扰素联合利巴韦林治疗慢性丙型肝炎疗效显著,可明显改善患者肝功能,具有较好的抗纤维化作用.     

Adverse effects during the treatment with pegylated interferon and ribavirin in children with chronic hepatitis C

PURPOSE: Administration of pegylated interferon-alpha (IFN-alpha) and ribavirin in adults with chronic hepatitis C (CHC) is a recommended therapeutic standard. Nevertheless, this therapeutic regimen rises numerous controversies. The aim of this study was to analyze adverse effects during the treatment with pegylated IFN-alpha and ribavirin in children with CHC. METHODS: Study group comprised 30 children with CHC, age 8-19 years (mean 13,6 years), 9 girls and 21 boys. All patients were administered two medication therapy with pegylated IFN-alpha-2b in the dose of 1.5 microg/kg of body weight 1x/week subcutaneously and daily oral ribavirin 15 mg/kg of bodyweight for 48 weeks. Blood samples were taken at baseline and every 4 weeks during the whole treatment and 24 weeks of follow-up period. Panel of test included: cellular blood count and smear, ALT activity, bilirubin level. Patients complaints were noticed during every visit. Thyroid hormones and antibodies were checked every 3 months. Children were divided into group A that responded to treatment and group B-nonresponders. RESULTS: Abnormalities in laboratory tests (white blood cells, neutrophils, haemoglobin) were observed mainly during first weeks of treatment. Mean bilirubin level and platelets were normal. Mean ALT normalized during the treatment. After 12-16 weeks of the therapy somatic adverse effects decreased significantly. CONCLUSIONS: Administration of pegylated IFN-alpha and ribavirin in children with CHC is related to characteristic adverse effects. Periodical dose reduction was necessary. Although side effects and subjective patient complaints were present, children attended school without difficulties. Constant monitoring is required during the whole treatment.     

Cochrane systematic review: pegylated interferon plus ribavirin vs. interferon plus ribavirin for chronic hepatitis C

BACKGROUND: About 170 million patients worldwide have chronic hepatitis C. Pegylated interferon plus ribavirin is currently the recommended therapy. AIM: To evaluate the beneficial and harmful effects of pegylated interferon plus ribavirin vs. interferon plus ribavirin for chronic hepatitis C infection. METHODS: We searched The Cochrane Library, MEDLINE, EMBASE, LILACS, Science Citation Index Expanded and contacted pharmaceutical companies and authors of trials (to March 2005). RESULTS: We included 18 randomized clinical trials with 4811 patients. Eleven trials (61%) had allocation bias risks and all had assessment bias risk because of lack of blinding. Compared with interferon plus ribavirin, pegylated interferon plus ribavirin had significant beneficial effects on sustained virological response [risk ratio (RR): 0.80; 95% CI: 0.74-0.88]. Data were insufficient to determine impact on long-term outcomes. Pegylated interferon plus ribavirin significantly increased dose reductions (RR: 1.44; 95% CI: 1.14-1.82) and adverse events including neutropenia (RR: 2.25; 95% CI: 1.58-3.21), thrombocytopenia (RR: 2.28; 95% CI: 1.14-4.54), arthralgia (RR: 1.19; 95% CI: 1.05-1.35), and injection-site reaction (RR: 2.56; 95% CI: 1.06-6.22). CONCLUSIONS: Pegylated interferon plus ribavirin compared with interferon plus ribavirin increased the proportion of patients with sustained virological response, but at the cost of more adverse events.     

Successful treatment of chronic hepatitis C with pegylated interferon in combination with ribavirin in a methadone maintenance treatment program

Injection drug users constitute 60% of the more than 4 million people in the United States with hepatitis C virus (HCV), including many methadone maintenance patients. Few data exist describing clinical outcomes for patients receiving HCV treatment on-site in methadone maintenance settings. In this retrospective study, we describe clinical outcomes for 73 patients receiving HCV treatment on-site in a methadone maintenance treatment program. Fifty-five percent of patients achieved end-of-treatment response, and 45% achieved sustained viral response. These treatment response rates are nearly equivalent to previously published HCV treatment response rates, despite high prevalences of ongoing drug use (49%), psychiatric comorbidity (67%), and HIV coinfection (32%). These data show that on-site HCV treatment with pegylated interferon and ribavirin is effective in methadone-maintained patients, many of whom are active drug users, psychiatrically ill, or HIV coinfected, and that methadone maintenance treatment programs represent an opportunity to safely treat chronic hepatitis C.     

PR 治疗慢性丙型肝炎患者营养风险的影响因素分析

摘要： 目的 探讨使用聚乙二醇干扰素联合利巴韦林 （PR） 治疗的慢性丙型肝炎 （丙肝） 患者出现营养风险的影响因素。方法 选取接受 PR 治疗的慢性丙肝患者 175 例, 测量身高、 体质量, 计算体质指数 （BMI）, 用营养风险筛查 2002 （NRS 2002） 来进行营养风险评估, 并分为有风险组 （140 例） 和无风险组 （35 例）。结果 2 组间年龄、 HCV 基因型、 临床类型、 治疗时间及干扰素或利巴韦林是否减量差异有统计学意义 （P＜0.05）。Logistic 回归分析显示： 高龄（OR 值 16.068, β 值 2.777）、 干扰素减量 （OR 值 3.096, β 值 1.130）、 利巴韦林减量 （OR 值 3.382, β 值 1.219） 以及进展至肝硬化的慢性丙肝 （OR 值 5.092, β 值 1.628） 为营养风险的危险因素; 而 HCV 基因型为非 1b 型者 （OR 值 0.384, β 值-0.957） 为营养风险的保护因素。结论 接受 PR 治疗的慢性丙肝患者营养风险发生率高。高龄、 对 PR 不耐受、慢性丙肝进展为肝硬化的患者为发生营养风险的独立危险因素, 而非 1b型 HCV 感染者不易发生营养风险。     

聚乙二醇干扰素治疗丙型肝炎的新进展

慢性丙型肝炎是一种严重威胁人类健康的疾病。聚乙二醇干扰素作为一种最近进入临床应用的药物 ,由于其独特的药动学特点在治疗慢性丙型肝炎的临床试验中显示出比普通干扰素更好的疗效。而聚乙二醇干扰素联合利巴韦林治疗目前被证明是治疗慢性丙型肝炎的最佳疗法。在临床试验中发现聚乙二醇干扰素的耐受性要优于普通干扰素     

Impact of ribavirin plasma level on sustained virological response in patients treated with pegylated interferon and ribavirin for chronic hepatitis C

Background  The main goal of therapy in hepatitis C virus (HCV) infection is to achieve a sustained virological response (SVR). However, the impact of the pharmacological properties of ribavirin on the SVR has not been fully investigated.
Aim  To evaluate, through a prospective study, the association between ribavirin plasma level and SVR response in HCV patients treated with pegylated interferon (PEG-IFN) and ribavirin.
Patients and methods  Patients treated with PEG-IFN and ribavirin had plasmatic ribavirin dosage at weeks 4 and 12. SVR was evaluated 6 months after the end of treatment.
Results  At week 4, a strong correlation was found between HCV-RNA and C _min of ribavirin plasma level ( r  = −0.376, P  = 0.002) and AUC _0→12h of ribavirin plasma level ( r  = −0.277, P  = 0.018). At week 12, a strong correlation was found between HCV-RNA and C _min of ribavirin plasma level ( r  = −0.384, P  < 0.0001) and AUC _0→12h of ribavirin plasma level ( r  = −0.257, P  = 0.002). In genotype 1 patients, AUC _0→12h ribavirin and C _min were significantly correlated with negative HCV-RNA at week 12 and SVR. In the multiple logistic regression model, the only factor independently associated with SVR in genotype 1 patients was negative HCV-RNA at week 12.
Conclusion  C_min of ribavirin at weeks 4 and 12 was significantly higher in sustained virological responders compared with relapser or nonresponder patients. However, in genotype 1 patients, plasma ribavirin level at weeks 4 and 2 was not associated with SVR.     

聚乙二醇干扰素与普通干扰素治疗慢性丙型肝炎的临床观察

目的探讨聚乙二醇干扰素(pegylated interferon,PEG-IFN)与普通干扰素(standard interferon,IFN)治疗慢性丙型肝炎的疗效和骨髓抑制情况。方法将61例接受PEG-IFN或IFN治疗的慢性丙型肝炎患者为研究对象,回顾性分析两组ALT复常、HCV-RNA阴转及骨髓抑制情况。结果慢性丙肝患者治疗4、12、24、48周,PEG-IFN组HCV-RNA水平显著低于IFN组;IFN组治疗12周、24周、48周及治疗后12周、24周HCV-RNA阴转率分别为34.48%、44.83%、55.17%、48.28%、37.93%,ALT复常率分别为55.17%、62.07%、65.52%、68.97%、65.52%;而PEG-IFN组HCV-RNA阴转率分别为50%、59.38%、71.88%、68.75%、62.5%,ALT复常率分别为65.63%、78.13%、84.38%、84.38%、81.25%。PEG-IFN组在ALT复常、HCV-RNA阴转率等方面疗效均明显高于IFN组。在24、48周时,PEG-IFN组WBC、Neu下降程度较IFN组明显,Plt只在24周差异较明显。按年龄分成3组后,PEG-IFN组的ALT复常率及HCV-RNA阴转率均显著高于IFN组。结论 PEG-IFN治疗慢性丙肝,在ALT复常率及HCV-RNA阴转率方面优于IFN,但骨髓抑制较明显。