中华实验和临床病毒学杂志
中華實驗和臨床病毒學雜誌
중화실험화림상병독학잡지
CHINESE JOURNAL OF EXPERIMENTAL AND CLINICAL VIROLOGY
2012年
5期
374-378
,共5页
李明慧%张艳丽%张璐%申戈%邱国华%路遥%庄立伟%高媛娇%杨民%吴云%谢尧%成军%徐道振
李明慧%張豔麗%張璐%申戈%邱國華%路遙%莊立偉%高媛嬌%楊民%吳雲%謝堯%成軍%徐道振
리명혜%장염려%장로%신과%구국화%로요%장립위%고원교%양민%오운%사요%성군%서도진
肝炎,丙型,慢性%抗病毒药%病毒应答%干扰素α%病毒载量%利巴韦林
肝炎,丙型,慢性%抗病毒藥%病毒應答%榦擾素α%病毒載量%利巴韋林
간염,병형,만성%항병독약%병독응답%간우소α%병독재량%리파위림
Hepatitis C,chronic%Antiviral agents%Viral response%Interferon-alpha%Viral Load%Libavirin
目的 探讨难治性慢性丙型肝炎强化治疗疗效,通过优化治疗剂量和疗程来提高慢性丙型肝炎患者对干扰素联合利巴韦林治疗的持续病毒应答率.方法 对常规治疗的干扰素剂量(聚乙二醇干扰素α每周皮下注射1次)和利巴韦林(每天10.5 mg/kg)经治的无应答和部分患者,根据患者的意愿进行标准干扰素α10 MU隔日注射1次或聚乙二醇干扰素α-2a(PEG-IFN α-2a)360 μg每周注射1次,并根据体重每天给予15 mg/kg的利巴韦林的强化剂量治疗,在治疗的0、4、12周和以后的每间隔12周、治疗结束后的24周进行HCV RNA含量检测,根据患者治疗过程中的病毒应答情况给予72 ～96周的疗程,以持续病毒应答(sustained viral response,SVR)作为疗效的评判指标.结果 18例患者完成全程治疗和观察,12例获得持续病毒学应答,5例治疗无效,1例复发.3例患者获得RVR,RVR获得者的cEVR和SVR均为3/3,RVR组治疗前的病毒载量显著低于未获得RVR组(t=4.687,P＜0.001).15例无快速病毒应答者,8例获得完全早期病毒应答,9例获得SVR.聚乙二醇干扰素α-2a 360 μg每周注射1次的SVR为4/5.11例获得cEVR患者均获得SVR,7例无cEVR的患者,仅1例获得SVR.结论 强化剂量的干扰素和RBV可以使较高比例的既往规范抗病毒治疗无应答、部分应答获得SVR.在强化治疗过程中根据病毒的应答情况及时调整和延长HCV RNA阴性的疗程是提高难治性慢性丙型肝炎持续病毒应答率的重要措施.
目的 探討難治性慢性丙型肝炎彊化治療療效,通過優化治療劑量和療程來提高慢性丙型肝炎患者對榦擾素聯閤利巴韋林治療的持續病毒應答率.方法 對常規治療的榦擾素劑量(聚乙二醇榦擾素α每週皮下註射1次)和利巴韋林(每天10.5 mg/kg)經治的無應答和部分患者,根據患者的意願進行標準榦擾素α10 MU隔日註射1次或聚乙二醇榦擾素α-2a(PEG-IFN α-2a)360 μg每週註射1次,併根據體重每天給予15 mg/kg的利巴韋林的彊化劑量治療,在治療的0、4、12週和以後的每間隔12週、治療結束後的24週進行HCV RNA含量檢測,根據患者治療過程中的病毒應答情況給予72 ～96週的療程,以持續病毒應答(sustained viral response,SVR)作為療效的評判指標.結果 18例患者完成全程治療和觀察,12例穫得持續病毒學應答,5例治療無效,1例複髮.3例患者穫得RVR,RVR穫得者的cEVR和SVR均為3/3,RVR組治療前的病毒載量顯著低于未穫得RVR組(t=4.687,P＜0.001).15例無快速病毒應答者,8例穫得完全早期病毒應答,9例穫得SVR.聚乙二醇榦擾素α-2a 360 μg每週註射1次的SVR為4/5.11例穫得cEVR患者均穫得SVR,7例無cEVR的患者,僅1例穫得SVR.結論 彊化劑量的榦擾素和RBV可以使較高比例的既往規範抗病毒治療無應答、部分應答穫得SVR.在彊化治療過程中根據病毒的應答情況及時調整和延長HCV RNA陰性的療程是提高難治性慢性丙型肝炎持續病毒應答率的重要措施.
목적 탐토난치성만성병형간염강화치료료효,통과우화치료제량화료정래제고만성병형간염환자대간우소연합리파위림치료적지속병독응답솔.방법 대상규치료적간우소제량(취을이순간우소α매주피하주사1차)화리파위림(매천10.5 mg/kg)경치적무응답화부분환자,근거환자적의원진행표준간우소α10 MU격일주사1차혹취을이순간우소α-2a(PEG-IFN α-2a)360 μg매주주사1차,병근거체중매천급여15 mg/kg적리파위림적강화제량치료,재치료적0、4、12주화이후적매간격12주、치료결속후적24주진행HCV RNA함량검측,근거환자치료과정중적병독응답정황급여72 ～96주적료정,이지속병독응답(sustained viral response,SVR)작위료효적평판지표.결과 18례환자완성전정치료화관찰,12례획득지속병독학응답,5례치료무효,1례복발.3례환자획득RVR,RVR획득자적cEVR화SVR균위3/3,RVR조치료전적병독재량현저저우미획득RVR조(t=4.687,P＜0.001).15례무쾌속병독응답자,8례획득완전조기병독응답,9례획득SVR.취을이순간우소α-2a 360 μg매주주사1차적SVR위4/5.11례획득cEVR환자균획득SVR,7례무cEVR적환자,부1례획득SVR.결론 강화제량적간우소화RBV가이사교고비례적기왕규범항병독치료무응답、부분응답획득SVR.재강화치료과정중근거병독적응답정황급시조정화연장HCV RNA음성적료정시제고난치성만성병형간염지속병독응답솔적중요조시.
Objective To explore the effect of intensive treatment for refractory chronic hepatitis C,and to improve the sustained viral response (SVR) rate of treatment with interferon plus ribavirin by optimizing therapeutic dose and course.Methods Patients who did not acquire response or partial response by standard therapy (PEG-IFN α subcutaneous injection weekly plus Ribavirin 10.5 mg/kg) every day were enrolled and retreated with intensive treatment of 10 MU interferon every other day or 360 μg pegylated interferon α-2a weekly according to patients' wishes,and ribavirin 15 mg/kg every day.Serum HCV RNA was detected at baseline,treatment week 4,12 and every 12 weeks succedent and 24 weeks after treatment end.Course of treatment was 72 to 96 weeks according to viral response.SVR was the mark of therapeutic effect.Results 18 patients completed whole range therapy and follow-up,in which 12 patients acquired SVR,5 patients treatment failure and 1 relapse.3 patients acquired rapid viral response(RVR),and they all got complete Early Viral Response (cEVR) and SVR.RVR Patients' viral loads were significantly lower than that of patients who did not acquire RVR(t =4.687,P ＜ 0.001).In 15 patients who did not acquire RVR,8 patients acquired cEVR,and 9 acquired SVR.SVR rate of patients who were administered PEG-IFN α-2a was 4/5,11 patients who acquired cEVR all acquired SVR,while in 7 patients who did not acquire cEVR,only 1 patient acquired SVR.Conclusions High percent patients,who did not acquire response or partial response by previous standard antiviral therapy,could gain SVR by intensive dose interferon plus Ribavirin.In intensive treatment procedure,adjusting and prolonging course according to viral response after HCV RNA turned negative were important measures to improve refractory Chronic Hepatitis C SVR rate.
