干扰素联合利巴韦林治疗慢性丙型肝炎患者的疗效

目的 研究昆明地区HCV感染者的病毒基因型分布,观察干扰素和利巴韦林联合治疗慢性丙型肝炎的疗效。 方法 采集60例慢性丙型肝炎患者的血液样品,采用特异性探针杂交法进行HCV基因分型,根据基因分型结果将患者分为HCV 1b型感染的长效干扰素治疗组（皮下注射聚乙二醇干扰素α-2a 180μg,1次/周）和非1b型感染的普通干扰素治疗组（皮下注射普通干扰素α-1b50μg,隔日1次）,两组患者均口服利巴韦林,剂量为900 ～ 1200 mg/d。治疗前后和随访中检测患者血浆HCV RNA和ALT水平作为疗效评价的指标。用x2检验比较治疗结束后HCV 1b基因型与HCV非1b基因型感染患者肝功能异常率的差异。结果 60例患者的血液样本中,HCV 1b基因型感染患者13例(21.7％),HCV 2a基因型3例(5.0％),HCV 3a基因型10例(16.7％),HCV 3b基因型29例(48.3％),HCV 6a基因型5例(8.3％);60例患者均完成治疗48周,长效干扰素治疗组和普通干扰素治疗组获得持续病毒学应答率分别为46.1％、74.5％;获得早期病毒学应答的患者全部获得持续病毒学应答。长效干扰素治疗组和普通干扰素治疗组在治疗后肝功能仍异常的患者分别占15.4％、14.9％,两组比较,x2=0.01,P＞0.05,差异无统计学意义。结论 (1)昆明地区HCV感染基因型以3b和1b为主;(2)聚乙二醇干扰素α-2a联合利巴韦林治疗HCV 1b型感染患者的疗效不理想;(3)早期病毒学应答是获得持续病毒学应答的重要预测因素。

Efficacy of interferon alpha with ribavirin for treatment of chronic Hepatitis C

Objective To investigate the prevalence and distribution of HCV genotypes and the clinical effect of interferon-α combined with ribavirin treatment in chronic hepatitis C patients in Kunming. Methods 60 patients were divided into two groups based on drug therapies: PEG-interferon-α plus ribavirin treatment group for HCV 1b and interferon -α plus ribavirin treatment group for non-HCV-1b. Serum ALT levels and HCV RNA quantitatious of the patients were detected during treatment and follow-up. Results The HCV genotypes of 60 patients were determined by type specific probe assay, and five different types were found. Their overall prevalence were 21.7％ for type 1b, 5％ for type 2a, 16.7％ for type3a, 48.3％ for type 3b, and 8.3％ for type 6a. Sustained viral response rates for PEG-interferon treatment group were 46.1％, for interferon treatment group were 74.4％. The abnormal rate of serum ALT after the treatment had no significant difference between HCV-1b and non-HCV-lb patients(P＞ 0.05). All patients with early viral responses got sustained viral response. Conclusion HCV-3b is the most dominant genotype in Kunming. The effect of PEG-interferon-α plus ribavirin treatment for genotype 1b is unsatisfactory. The early viral response is a good predictor for the responses to antiviral therapy in chronic hepatitis C patients.