CAJ | 학술논문

目的观察和分析慢性丙型肝炎患者经干扰素联合利巴韦林治疗获得应答后的复发情况及其影响因素.方法收集长期随访资料完整的慢性丙型肝炎患者资料纳入回顾性统计分析.治疗方案为聚乙二醇干扰素或普通干扰素联合利巴韦林治疗,疗程依基因型分别为24周(非1b型)或48周(1b型).主要观察指标为血清HCV RNA载量,影响因素纳入了年龄、性别、HCV基因型、基线HCV RNA载量及干扰素类型.计量资料用t检验,计数资料用x2检验,影响因素的分析用二分类logistic回归分析.结果 146例慢性丙型肝炎患者抗病毒治疗结束后平均随访(33.5±16.4)个月,最短12个月,最长85个月,累计复发率为14.8％.随访第1～6个月内复发概率最大,为8.9‰第7～12个月为1.4％、第13～18个月为1.4％、第19～24个月为1.6％、第25～30个月为1.1,30个月后未见复发.65.0％(13/20)的复发病例发生于治疗结束后6个月内,但之后2年内仍有35.0％(7/20)病例复发.HCV基因1b型和非1b型患者复发率分别为20.4％和12.2％,两组比较,差异无统计学意义(P＞0.05).复发和未复发患者平均基线HCV RNA载量分别为(6.86±1.01)log10拷贝/ml和(6.60±1.21)log10拷贝/ml,两组比较,差异无统计学意义(P＞0.05)；聚乙二醇干扰素α-2b,聚乙二醇干扰素α-2a及普通干扰素α治疗后复发率分别为12.1％、14.0％及15.0‰组间比较,差异无统计学意义(P＞0.05);复发患者的平均年龄为(46.15±11.89)岁,高于未复发患者的(37.41±10.65)岁,两组比较,差异有统计学意义(t=3.352,P=0.001).结论接受病毒基因型指导的标准抗病毒方案的患者,只有年龄与复发显著相关,高龄患者容易复发.基因型指导的抗病毒方案基本上消除了病毒因素对治疗应答的影响.
목적 관찰화분석만성병형간염환자경간우소연합리파위림치료획득응답후적복발정황급기영향인소.방법 수집장기수방자료완정적만성병형간염환자자료납입회고성통계분석.치료방안위취을이순간우소혹보통간우소연합리파위림치료,료정의기인형분별위24주(비1b형)혹48주(1b형).주요관찰지표위혈청HCV RNA재량,영향인소납입료년령、성별、HCV기인형、기선HCV RNA재량급간우소류형.계량자료용t검험,계수자료용x2검험,영향인소적분석용이분류logistic회귀분석.결과 146례만성병형간염환자항병독치료결속후평균수방(33.5±16.4)개월,최단12개월,최장85개월,루계복발솔위14.8％.수방제1～6개월내복발개솔최대,위8.9‰제7～12개월위1.4％、제13～18개월위1.4％、제19～24개월위1.6％、제25～30개월위1.1,30개월후미견복발.65.0％(13/20)적복발병례발생우치료결속후6개월내,단지후2년내잉유35.0％(7/20)병례복발.HCV기인1b형화비1b형환자복발솔분별위20.4％화12.2％,량조비교,차이무통계학의의(P＞0.05).복발화미복발환자평균기선HCV RNA재량분별위(6.86±1.01)log10고패/ml화(6.60±1.21)log10고패/ml,량조비교,차이무통계학의의(P＞0.05)；취을이순간우소α-2b,취을이순간우소α-2a급보통간우소α치료후복발솔분별위12.1％、14.0％급15.0‰조간비교,차이무통계학의의(P＞0.05);복발환자적평균년령위(46.15±11.89)세,고우미복발환자적(37.41±10.65)세,량조비교,차이유통계학의의(t=3.352,P=0.001).결론 접수병독기인형지도적표준항병독방안적환자,지유년령여복발현저상관,고령환자용역복발.기인형지도적항병독방안기본상소제료병독인소대치료응답적영향.
Objective To investigate viral relapse and the associated risk factors during a long-term follow-up study of chronic hepatitis C (CHC) patients who acheived end-of-treatment response (ETR) after interferon and ribavirin therapy.Methods This retrospective study was conducted on 146 CHC patients treated with a combination of ribavirin and pegylated (PEG) interferon-alpha (IFNα) (n=126) or conventional IFNα (n =20) for 24 (hepatitis C virus (HCV) non-genotype 1b) or 48 (HCV genotype 1b) weeks.The main outcome measure was serum HCV RNA load.The risk factors analyzed included age,sex,HCV genotype,baseline HCV RNA load,and IFN type.Results The mean follow-up time for all patients was 33.45± 16.41months (range:12-85 months).The cumulative relapse rate during follow-up was 14.80％.The relapse rate within six months (8.90％) was significantly higher than other periods during two years of follow-up,and no relapse occmred after 30 months.Of all relapsers (n =20),65％ occurred within six months,followed by 35％within 7-24 months after antiviral therapy.The relapse rates in patients with HCV genotype 1b and non-1b were not significantly different (20.37％ vs.12.12％,x2 =1.517,P=0.315).The mean baseline HCV RNAload was significantly higher in the relapsers than that in the non-relapsers (t=0.915,P=0.362).Relapse rates were similar in patients treated with PEG-IFNα-2b,PEG-IFNα-2a and IFNα (12.12％ vs.13.97％ vs.15.00％,respectifively; x2 =0.104,p=0.949).The mean age of relapsers was significantly higher than that of non-relapsers (P＜0.005).Conclusion The maximum probability of relapse for CHC patients exists within six months from when ETR is achieved by interferon and ribavirin therapy.A lower risk for relapse persists past this period.Thus,ETR CHC patients,especially older patients,should be carefully monitored during the two years after cessation of antiviral therapy.Standard antiviral therapy based on HCV genotype eliminates the influence of viral factors on treatment-response.