中华肝脏病杂志
中華肝髒病雜誌
중화간장병잡지
CHINESE JOURNAL OF HEPATOLOGY
2011年
11期
823-827
,共5页
余兰辉%林潮双%蔡庆贤%张晓红%吴元凯%赵志新%高志良
餘蘭輝%林潮雙%蔡慶賢%張曉紅%吳元凱%趙誌新%高誌良
여란휘%림조쌍%채경현%장효홍%오원개%조지신%고지량
肝炎,丙型,慢性%肝炎病毒,丙型%预后%随访研究%干扰素%治疗
肝炎,丙型,慢性%肝炎病毒,丙型%預後%隨訪研究%榦擾素%治療
간염,병형,만성%간염병독,병형%예후%수방연구%간우소%치료
Hepatitis C,chronic%Hepatitis C Virus%Prognosis%Follow-up studies%Interferon%Therapy
目的 探讨慢性丙型肝炎患者的临床转归及干扰素干预对临床转归的影响.方法 采用回顾性调查与前瞻性研究相结合的方法,对136例慢性丙型肝炎患者进行定群随访,采用SPSS16.0统计软件包进行x2检验及多元logistic回归分析.结果 136例患者以输血及血制品感染为主,诊断时间主要集中在2000-2005年,其中,98例用干扰素联合利巴韦林抗病毒治疗,余38例患者未行干扰素治疗；136例患者中,5年来新增12例肝硬化或肝癌患者,占8.8％;76例经干扰素治疗有效患者,5年来,46例复发,占60.5％.5年随访肝癌及肝硬化发生率:136例患者中,年龄＜40岁的患者发生率为0;40～60岁的患者发生率为12.5％ (7/56);年龄≥60岁的患者发生率为35.7％ (10/28),多元logistic回归分析,差异有统计学意义(B=0.111,Wald=4.324,P=0.038).AST水平正常或2倍正常值上限以内为0,2～4倍为43.5％(10/23),4倍以上为58.3％ (7/12),多元logistic回归分析,差异有统计学意义(B=2.184,Wald=5.443,P=0.02).患者经聚乙二醇干扰素治疗后复发率为29.7％(11/37),普通干扰素治疗复发率为89.7％ (35/39),两者比较差异有统计学意义(Logistic回归分析B=-2.077,Wald=4.352,P=0.037).而总疗程＜24周的患者,复发率为100％(15/15);总疗程在24 ～ 48周的患者,复发率为76.2％ (16/21);疗程≥48周的患者,复发率为37.5％ (15/40),差异有统计学意义(Logistic回归分析B=-1.632,Wald=6.651,P=0.01).46例复发患者中42例再次接受干扰素治疗,HCV RNA均可转阴.结论 丙型肝炎病毒感染增加肝硬化、肝癌的风险,干扰素干预能有效抑制病毒,改善预后.通过使用聚乙二醇干扰素替代普通干扰素及延长疗程治疗可降低复发率.
目的 探討慢性丙型肝炎患者的臨床轉歸及榦擾素榦預對臨床轉歸的影響.方法 採用迴顧性調查與前瞻性研究相結閤的方法,對136例慢性丙型肝炎患者進行定群隨訪,採用SPSS16.0統計軟件包進行x2檢驗及多元logistic迴歸分析.結果 136例患者以輸血及血製品感染為主,診斷時間主要集中在2000-2005年,其中,98例用榦擾素聯閤利巴韋林抗病毒治療,餘38例患者未行榦擾素治療；136例患者中,5年來新增12例肝硬化或肝癌患者,佔8.8％;76例經榦擾素治療有效患者,5年來,46例複髮,佔60.5％.5年隨訪肝癌及肝硬化髮生率:136例患者中,年齡＜40歲的患者髮生率為0;40～60歲的患者髮生率為12.5％ (7/56);年齡≥60歲的患者髮生率為35.7％ (10/28),多元logistic迴歸分析,差異有統計學意義(B=0.111,Wald=4.324,P=0.038).AST水平正常或2倍正常值上限以內為0,2～4倍為43.5％(10/23),4倍以上為58.3％ (7/12),多元logistic迴歸分析,差異有統計學意義(B=2.184,Wald=5.443,P=0.02).患者經聚乙二醇榦擾素治療後複髮率為29.7％(11/37),普通榦擾素治療複髮率為89.7％ (35/39),兩者比較差異有統計學意義(Logistic迴歸分析B=-2.077,Wald=4.352,P=0.037).而總療程＜24週的患者,複髮率為100％(15/15);總療程在24 ～ 48週的患者,複髮率為76.2％ (16/21);療程≥48週的患者,複髮率為37.5％ (15/40),差異有統計學意義(Logistic迴歸分析B=-1.632,Wald=6.651,P=0.01).46例複髮患者中42例再次接受榦擾素治療,HCV RNA均可轉陰.結論 丙型肝炎病毒感染增加肝硬化、肝癌的風險,榦擾素榦預能有效抑製病毒,改善預後.通過使用聚乙二醇榦擾素替代普通榦擾素及延長療程治療可降低複髮率.
목적 탐토만성병형간염환자적림상전귀급간우소간예대림상전귀적영향.방법 채용회고성조사여전첨성연구상결합적방법,대136례만성병형간염환자진행정군수방,채용SPSS16.0통계연건포진행x2검험급다원logistic회귀분석.결과 136례환자이수혈급혈제품감염위주,진단시간주요집중재2000-2005년,기중,98례용간우소연합리파위림항병독치료,여38례환자미행간우소치료；136례환자중,5년래신증12례간경화혹간암환자,점8.8％;76례경간우소치료유효환자,5년래,46례복발,점60.5％.5년수방간암급간경화발생솔:136례환자중,년령＜40세적환자발생솔위0;40～60세적환자발생솔위12.5％ (7/56);년령≥60세적환자발생솔위35.7％ (10/28),다원logistic회귀분석,차이유통계학의의(B=0.111,Wald=4.324,P=0.038).AST수평정상혹2배정상치상한이내위0,2～4배위43.5％(10/23),4배이상위58.3％ (7/12),다원logistic회귀분석,차이유통계학의의(B=2.184,Wald=5.443,P=0.02).환자경취을이순간우소치료후복발솔위29.7％(11/37),보통간우소치료복발솔위89.7％ (35/39),량자비교차이유통계학의의(Logistic회귀분석B=-2.077,Wald=4.352,P=0.037).이총료정＜24주적환자,복발솔위100％(15/15);총료정재24 ～ 48주적환자,복발솔위76.2％ (16/21);료정≥48주적환자,복발솔위37.5％ (15/40),차이유통계학의의(Logistic회귀분석B=-1.632,Wald=6.651,P=0.01).46례복발환자중42례재차접수간우소치료,HCV RNA균가전음.결론 병형간염병독감염증가간경화、간암적풍험,간우소간예능유효억제병독,개선예후.통과사용취을이순간우소체대보통간우소급연장료정치료가강저복발솔.
Objective To investigate the clinical outcome and effect of interferon treatment on patients with chronic hepatitis C.Methods 136 cases of patients with chronic hepatitis C were followed up by methods of retrospective survey combined with prospective study.SPSS16.0 was used to perform chisquare test and multiple logistic regression.Results 136 cases of patients were infected with HCV virus mainly through blood and blood products transfusion.They were diagnosed mainly between 2000 and 2005.98 cases of them had anti-viral treatment with interferon and ribavirin,while the rest did not; 12 new cases developed HCV-related cirrhosis or liver carcinoma in five years,which accounted for 8.8％ of the total.Among 76 cases once treated with interferon,46 cases (60.5％) relapsed in five years.For patients with age ＜ 40,the rates of cirrhosis and liver cancer were o,and patients with age ≥ 40 but ＜ 60 years,the rates of cirrhosis and liver cancer were 12.5％ (7/56 cases),while for those ≥ 60 years old the rates were 35.7％ (10/28cases).The difference was significant (B =0.111,Wald =4.324,P =0.038) as analysed by logistic regression.The rates of cirrhosis and liver cancer were zero for those with normal or within twice the upper normal AST limit in five years,43.5％ (10/23 cases) for those with AST ranging from 2 to 4 fold the upper normal limit,and 58.3％ (7/12 cases) for those with AST higher than four times the upper normal limit.The difference was also significant (B =2.184,Wald =5.443,P =0.02) by logistic regression analysis.The rate of relapse was 29.7％ (11/37 cases) for those using pegylated interferon and 89.7％ (35/39 cases) for those using interferon.The difference was significant ( Result of logistic regression showed-B =-2.077,Wald =4.352,P =0.037).The rate of relapse was 100％ (15/15 cases) for those with treatment less than 24 weeks,76.2％ (16/21 cases)for those with treatment more than 24 weeks but less than 48 weeks,and 37.5％ (14/40 cases) for those with treatment more than 48 weeks.The difference was significant ( Result of logistic regression showed-B =-1.632,Wald =6.651,P =0.01).42 cases of the relapsed (91.3％) were administrated with interferon once again with ideal effect.Conclusion Hepatitis C virus infection increases the risk of liver cirrhosis and liver cancer.Interferon combined with ribavirin therapy could effectively control the virus and improve outcomes.We can reduce the incidence of relapse by chosing the treatment of pegylated interferon instead of interferon and by completing the full treatment.
