CAJ | 학술논문

目的：探讨老年慢性丙型肝炎患者抗病毒疗效及影响因素。方法回顾性分析42例老年慢性丙型肝炎患者经聚乙二醇干扰素（Peg-IFNα-2a）联合利巴韦林治疗48周随访24周的病毒学应答、复发及无应答情况，分析与病毒学应答相关的影响因素。结果42例老年慢性丙型肝炎患者获得快速病毒学应答（RVR）、早期病毒学应答（EVR）、持续病毒学应答（SVR）比例分别为42．9％、78．6％、57．1％，复发率为26．2％，无应答率为21．4％。RVR组、EVR组的SVR为77．8％、72．7％，均高于非 RVR 组、非 EVR 组的41．7％、0（P 值分别为0．02、0．00）。SVR 组的病程（10．0±4．6）年、基线 HCV RNA（5．67±0．82）lg拷贝/mL、基因Ⅰ型占45．8％，显著低于非SVR组的（17．2±5．6）年、（6．39±0．92）lg拷贝/mL 和83．3％（P 值分别为0．00、0．02、0．01）；IL-28B 基因多态性 CC 等位基因为83．3％，明显高于非SVR组的50％（P＝0．02）。81％的老年慢性丙型肝炎患者感染途径是有手术史或输血史，78．6％的患者病程＞10年。结论老年慢性丙型肝炎患者可获得较高的病毒学应答率。感染 HCV 年限、基线 HCV RNA 载量、非基因Ⅰ型以及IL-28B等位基因CC型和RVR、EVR是预测抗病毒疗效的影响因素。
목적：탐토노년만성병형간염환자항병독료효급영향인소。방법회고성분석42례노년만성병형간염환자경취을이순간우소（Peg-IFNα-2a）연합리파위림치료48주수방24주적병독학응답、복발급무응답정황，분석여병독학응답상관적영향인소。결과42례노년만성병형간염환자획득쾌속병독학응답（RVR）、조기병독학응답（EVR）、지속병독학응답（SVR）비례분별위42．9％、78．6％、57．1％，복발솔위26．2％，무응답솔위21．4％。RVR조、EVR조적SVR위77．8％、72．7％，균고우비 RVR 조、비 EVR 조적41．7％、0（P 치분별위0．02、0．00）。SVR 조적병정（10．0±4．6）년、기선 HCV RNA（5．67±0．82）lg고패/mL、기인Ⅰ형점45．8％，현저저우비SVR조적（17．2±5．6）년、（6．39±0．92）lg고패/mL 화83．3％（P 치분별위0．00、0．02、0．01）；IL-28B 기인다태성 CC 등위기인위83．3％，명현고우비SVR조적50％（P＝0．02）。81％적노년만성병형간염환자감염도경시유수술사혹수혈사，78．6％적환자병정＞10년。결론노년만성병형간염환자가획득교고적병독학응답솔。감염 HCV 년한、기선 HCV RNA 재량、비기인Ⅰ형이급IL-28B등위기인CC형화RVR、EVR시예측항병독료효적영향인소。
Objective To explore antiviral efficacy and the influencing factors in elderly patients with chronic hepatitis C. Methods Clinical data for 42 elderly patients with chronic hepatitis C were analyzed retrospectively. Influencing factors of virological response were evaluated. Results Forty-two elderly patients with chronic hepatitis C, who received peginterferon (Peg-interferonsα-2 a)plus ribavirin treatment for 48 weeks,were followed-up for 24 weeks. Proportions of rapid virological response (RVR ),early virological response (EVR ),sustained virological response (SVR)were 42.9% ,42.9% and 57.1% ,respectively. Relapse rate was 26.2% ,and non-response rate was 21 .4% . SVR in RVR or EVR group(77.8% ,72.7% )was higher than that in non-RVR or non-EVR group(41 .7% ,0% )(P=0.02,0.00). Compared with non-SVR group,SVR group had significantly shorter disease course (10.0±4.62 years vs. 17.2±5.63 years,P= 0.00),lower HCV RNA level at baseline (5.67±0.82 log10 copies/ml vs. 6.39±0.92 log10 copies/ml,P= 0.00)and less genotype I patients (45.8% vs. 83.3% ,P= 0.01 ). IL-28B gene polymorphism CC (83.3% )was significantly higher in SVR group than that in non-SVR group (50% )(P= 0.02). Eighty-one percent of the elderly patients with chronic hepatitis C had histories of surgery or blood transfusion,and 78 .6% of those patients′disease courses were more than ten years. Conclusion Elderly patients with chronic hepatitis C can obtain higher virological response rates. Disease course of hepatitis C, HCV RNA loads at baseline, genotype, IL-28B gene polymorphism CC,RVR and EVR are influencing factors which could predict the efficacy of antiviral therapy. Elderly patients with chronic hepatitis C should be paid more attention to early screening,early diagnosis and early treatment.