聚乙二醇干扰素α-2a与普通干扰素α-2b联合利巴韦林治疗慢性丙型肝炎患者疗效比较和影响疗效的预测因素分析

目的 比较聚乙二醇干扰素α-2a与普通干扰素α-2b联合利巴韦林治疗慢性丙型肝炎患者的疗效,并对影响抗病毒疗效的因素进行分析。方法 2010年5月~2014年8月我院收治的慢性丙型肝炎患者116例,随机将患者分为研究组和对照组,每组58例。给予对照组患者普通干扰素α-2b 联合利巴韦林治疗,给予研究组患者聚乙二醇α-2a干扰素联合利巴韦林治疗。采用实时荧光定量PCR法检测血清HCV RNA定量,对两组病毒学应答率以及性别、年龄、体质指数和病毒载量对治疗效果的影响进行比较分析。结果 在治疗12周、24周、48周以及停药后12周和24周,研究组患者血清HCV RNA转阴率分别为51.72%、60.34%、72.41%、68.97%和65.52%,显著高于对照组患者的31.03%、48.27%、55.17%、48.27%和41.38% （P<0.05）;研究组患者快速病毒学应答率、早期病毒学应答率、治疗结束病毒学应答率和持续病毒学应答率分别为75.86%、84.48%、86.20%和74.14%,显著高于对照组的51.72%、60.34%、63.79%和55.17%（P<0.05）;在治疗4周、12周、24周和48周,研究组患者血清HCV RNA水平分别为（4.72±1.30） IU/ml、（4.09±1.21） IU/ml、（3.79±1.18） IU/ml和（3.26±1.08） IU/ml,显著低于对照组患者的（5.27±1.52） IU/ml、（4.68±1.41） IU/ml、（4.15±1.37） IU/ml和（3.99±1.16） IU/ml（P<0.05）;两组患者在治疗过程中,均出现发热、失眠、肌肉酸痛、乏力和白细胞下降等不良反应,但差异均不具有统计学意义（P>0.05）;研究组获得SVR患者治疗前血清HCV RNA水平为（3.57±0.45） IU/ml,显著低于未获得SVR患者的（4.92±0.09） IU/ml（P<0.05）。讨论 聚乙二醇干扰素α-2a联合利巴韦林治疗慢性丙型肝炎患者有效且安全,治疗前患者病毒载量低将预示疗效好。

Comparison of efficacy of peginterferon α-2a and interferon α-2b combined with ribavirin in treatment of patients with chronic hepatitis C

Objective To compare the efficacy of peginterferon α-2a and interferon α-2b combined with ribavirin in treatment of patients with chronic hepatitis C. Methods 116 chronic hepatitis C patients were selected in our hospital between May 2010 and August 2014. The patients were randomly divided into observation group and control group,with 58 cases in each group. The patients in control group were treated with interferon α-2b combined with ribavirin and the patients in observation group were treated with peginterferon α-2a combined with ribavirin. Serum HCV RNA levels and virological response,and the gender,age,body mass index in the two groups were compared and analyzed. Results Serum HCV RNA negative rates were 51.72%,60.34%,72.41%,68.97%,65.52% in patients in observation group at 12 weeks,24 weeks,48 weeks and 12 and 24 weeks after discontinuation of the regimen,which were significantly higher than those in the control group（31.03%, 48.27%,55.17%,48.27%,41.38%,respectively,P<0.05）;the RVR,EVR,ETVR and SVR in the observation group were 75.86%,84.48%,86.20%,74.14%,significantly higher than those in the control group（51.72%,60.34%,63.79%,55.17%,P<0.05）;serum levels of HCV RNA in the observation group at 4 weeks,12 weeks,24 weeks and 48 weeks were（4.72±1.30） IU/ml,（4.09±1.21） IU/ml,（3.79±1.18） IU/ml,（3.26±1.08） IU/ml,which were significantly lower than those in the control group [（5.27±1.52） IU/ml,（4.68±1.41） IU/ml,（4.15±1.37） IU/ml,（3.99±1.16） IU/ml,P<0.05];the adverse events,including fever,insomnia,fatigue and leukopenia occurred during treatment in the two groups,and there was no significant differences between them （P>0.05）;serum HCV RNA levels at presentation in patients having SVR in the observation group was（3.57±0.45） IU/ml,significantly lower than that in those without SVR [（4.92±0.09） IU/ml,P<0.05]. Conclusion s Peginterferon α-2a combinded with ribavirin treatment could improve the efficacy in patients with chronic hepatitis C,and also have a good safety. This study hints that the regimen will get a good response in patients with low HCV RNA load at admission.