中华消化杂志
中華消化雜誌
중화소화잡지
Chinese Journal of Digestion
2015年
10期
668-672
,共5页
徐严%张永贵%亓文骞%王眭%王江滨
徐嚴%張永貴%亓文鶱%王眭%王江濱
서엄%장영귀%기문건%왕휴%왕강빈
聚乙二醇干扰素α-2a%肝炎,丙型%失代偿期肝硬化%累积剂量
聚乙二醇榦擾素α-2a%肝炎,丙型%失代償期肝硬化%纍積劑量
취을이순간우소α-2a%간염,병형%실대상기간경화%루적제량
Peg-IFNα-2a%Hepatitis C%Decompensated liver cirrhosis%Cumulative dose
目的 观察聚乙二醇干扰素(Peg-IFN )α-2a联合利巴韦林累积剂量对失代偿期丙型肝炎肝硬化患者的疗效 ,评价抗病毒治疗对疾病进展的影响.方法 纳入2005年1月至2009年3月的失代偿期丙型肝炎肝硬化患者 ,对血细胞达到 IFN 治疗标准的患者(包括行脾动脉栓塞术的患者)予Peg-IFNα-2a联合利巴韦林治疗 ,治疗中根据耐受情况调整Peg-IFNα-2a和利巴韦林的用量 ,治疗结束后随访24周 ;将血细胞未达到治疗标准或不愿进行抗病毒治疗的患者作为对照组 ,随访96周.以累积药物暴露剂量来计算应用药物的总量.观察病毒持续应答率(SVR)、复发率、肝功能和疾病进展状况.组间比较采用 t检验或卡方检验 ,疾病进展率比较采用Kaplan-M eier曲线.结果 抗病毒治疗结束后 , Peg-IFNα-2a和利巴韦林累积剂量≥60% 者 ,SVR分别为27 .3% (12/44)和27 .7% (13/47) ,复发率分别为7/19和35 .0% (7/20 );累积剂量<60% 者 ,S V R分别为1/7和1/4 ,复发率均为1/2 ;不同累积剂量比较差异均无统计学意义( P均> 0 .05 ).联合治疗组在治疗结束后随访24周时的Child-Pugh评分为(7.9±1.4)分 ,低于治疗前的(8.5±1.2)分 ,差异有统计学意义(t=2.33,P=0.02);对照组在随访96周时的Child-Pugh评分为(10 .0 ± 1 .6)分 ,高于治疗前的(8 .5 ± 1 .4)分 ,差异有统计学意义(t=5 .82 ,P<0 .01 ).联合治疗组的总体疾病进展率为15 .7% ,低于对照组的32 .4% ,差异有统计学意义(χ2 =4 .34 , P=0 .04).结论 采用非标准剂量Peg-IFNα-2a联合利巴韦林抗病毒治疗失代偿期丙型肝炎肝硬化患者 ,只要累积剂量达到一定标准 ,就可获得病毒学应答 ,改善患者的Child-Pugh评分 ,延缓疾病进展.
目的 觀察聚乙二醇榦擾素(Peg-IFN )α-2a聯閤利巴韋林纍積劑量對失代償期丙型肝炎肝硬化患者的療效 ,評價抗病毒治療對疾病進展的影響.方法 納入2005年1月至2009年3月的失代償期丙型肝炎肝硬化患者 ,對血細胞達到 IFN 治療標準的患者(包括行脾動脈栓塞術的患者)予Peg-IFNα-2a聯閤利巴韋林治療 ,治療中根據耐受情況調整Peg-IFNα-2a和利巴韋林的用量 ,治療結束後隨訪24週 ;將血細胞未達到治療標準或不願進行抗病毒治療的患者作為對照組 ,隨訪96週.以纍積藥物暴露劑量來計算應用藥物的總量.觀察病毒持續應答率(SVR)、複髮率、肝功能和疾病進展狀況.組間比較採用 t檢驗或卡方檢驗 ,疾病進展率比較採用Kaplan-M eier麯線.結果 抗病毒治療結束後 , Peg-IFNα-2a和利巴韋林纍積劑量≥60% 者 ,SVR分彆為27 .3% (12/44)和27 .7% (13/47) ,複髮率分彆為7/19和35 .0% (7/20 );纍積劑量<60% 者 ,S V R分彆為1/7和1/4 ,複髮率均為1/2 ;不同纍積劑量比較差異均無統計學意義( P均> 0 .05 ).聯閤治療組在治療結束後隨訪24週時的Child-Pugh評分為(7.9±1.4)分 ,低于治療前的(8.5±1.2)分 ,差異有統計學意義(t=2.33,P=0.02);對照組在隨訪96週時的Child-Pugh評分為(10 .0 ± 1 .6)分 ,高于治療前的(8 .5 ± 1 .4)分 ,差異有統計學意義(t=5 .82 ,P<0 .01 ).聯閤治療組的總體疾病進展率為15 .7% ,低于對照組的32 .4% ,差異有統計學意義(χ2 =4 .34 , P=0 .04).結論 採用非標準劑量Peg-IFNα-2a聯閤利巴韋林抗病毒治療失代償期丙型肝炎肝硬化患者 ,隻要纍積劑量達到一定標準 ,就可穫得病毒學應答 ,改善患者的Child-Pugh評分 ,延緩疾病進展.
목적 관찰취을이순간우소(Peg-IFN )α-2a연합리파위림루적제량대실대상기병형간염간경화환자적료효 ,평개항병독치료대질병진전적영향.방법 납입2005년1월지2009년3월적실대상기병형간염간경화환자 ,대혈세포체도 IFN 치료표준적환자(포괄행비동맥전새술적환자)여Peg-IFNα-2a연합리파위림치료 ,치료중근거내수정황조정Peg-IFNα-2a화리파위림적용량 ,치료결속후수방24주 ;장혈세포미체도치료표준혹불원진행항병독치료적환자작위대조조 ,수방96주.이루적약물폭로제량래계산응용약물적총량.관찰병독지속응답솔(SVR)、복발솔、간공능화질병진전상황.조간비교채용 t검험혹잡방검험 ,질병진전솔비교채용Kaplan-M eier곡선.결과 항병독치료결속후 , Peg-IFNα-2a화리파위림루적제량≥60% 자 ,SVR분별위27 .3% (12/44)화27 .7% (13/47) ,복발솔분별위7/19화35 .0% (7/20 );루적제량<60% 자 ,S V R분별위1/7화1/4 ,복발솔균위1/2 ;불동루적제량비교차이균무통계학의의( P균> 0 .05 ).연합치료조재치료결속후수방24주시적Child-Pugh평분위(7.9±1.4)분 ,저우치료전적(8.5±1.2)분 ,차이유통계학의의(t=2.33,P=0.02);대조조재수방96주시적Child-Pugh평분위(10 .0 ± 1 .6)분 ,고우치료전적(8 .5 ± 1 .4)분 ,차이유통계학의의(t=5 .82 ,P<0 .01 ).연합치료조적총체질병진전솔위15 .7% ,저우대조조적32 .4% ,차이유통계학의의(χ2 =4 .34 , P=0 .04).결론 채용비표준제량Peg-IFNα-2a연합리파위림항병독치료실대상기병형간염간경화환자 ,지요루적제량체도일정표준 ,취가획득병독학응답 ,개선환자적Child-Pugh평분 ,연완질병진전.
Objective To observe the efficacy of cumulative dose of polyethylene glycol-interferon (Peg-IFN)α-2a combined with ribavirin in patients with decompensated hepatitis C virus (HCV)-related liver cirrhosis , and to evaluate the effects of anti-virus therapy on the progress of the disease . Methods From January 2005 to March 2009 ,patients with decompensated HCV-related liver cirrhosis were enrolled ,also included patients received partial splenic embolization .Peg-IFNα-2a combined with ribavirin therapy was given to patients whose blood cell met interferon (IFN) therapy standards .The dosage of Peg-IFNα-2a and ribavirin was adjusted according to the tolerance of the patients .After the treatment ,the patients were followed-up for 24 weeks .The patients whose blood cell did not meet IFN therapy standards and the patients unwilling to receive anti-virus therapy were assigned to control group and were followed-up for 96 weeks .The total amount of medication was calculated according to cumulative exposure dose . Sustained virological response (SVR ) , recurrence rate , liver function and disease progression were observed .The t test or Chi-square test was performed for comparison between groups and rate of disease progression was analyzed with Kaplan Meier curve .Results After anti-virus therapy , SVRs of patients with cumulative dose of Peg-IFNα-2a and ribavirin over 60% (include 60% ) were 27 .3%(12/44) and 27 .7% (13/47) ,respectively ;the recurrence rates were 7/19 and 35 .0% (7/20) ,respectively . In patients with cumulative dose less than 60% ,SVRs were 1/7 and 1/4 ,respectively ,and the recurrence rates were both 1/2 ;the differences of different doses was not statistically significant (all P>0 .05) .At the 24th week of follow-up after therapy ,the Child-Pugh score of combined therapy group was 7 .9 ± 1 .4 , which was lower than that before treatment (8 .5 ± 1 .2) ,and the difference was statistically significant (t=2 .33 ,P=0 .02) .At the 96th week of follow-up ,the Child-Pugh score of control group was 10 .0 ± 1 .6 ,which was higher than that before treatment (8 .5 ± 1 .4) ,and the difference was statistically significant (t=5 .82 , P<0 .01) .The disease progression rate of combined therapy group was 15 .7% , which was lower than that of control group (32 .4% ) ,and the difference was statistically significant (χ2=4 .34 ,P= 0 .04) .Conclusion The application of non-standard dosage of Peg-IFNα-2a combined with ribavirin in the patients with decompensated HCV-related liver cirrhosis can achieve virological response once the cumulative dose reached certain standards ,improve Child-Pugh scores of patients and slow disease progression .
