慢性丙型肝炎患者标准化治疗应答的相关因素分析
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摘要
目的探讨慢性丙型肝炎(CHC)标准化抗病毒治疗应答的影响因素,为临床提供参考价值。方法选择97例CHC患者,分别检测丙型肝炎病毒(HCV)基因型、HCV RNA和白细胞介素-28B(IL-28B)位点rs8099917基因型。患者均接受标准化抗病毒治疗。分析获得快速病毒学应答(RVR)、早期病毒学应答(EVR)、治疗结束时病毒学应答(ETVR)和持续病毒学应答(SVR)的影响因素。结果 HCV基因1型组和非1型组、rs8099917基因TT型组和GT+GG型组的RVR、EVR、ETVR和SVR差异具均有统计学意义(χ2=9.359、11.440、6.346、8.147、9.938、7.413、4.564和4.229,P<0.05)。获得RVR的独立影响因素为HCV基因非1型、高ALT和AST水平、低HCV RNA载量以及rs8099917基因TT型;获得EVR的独立影响因素为HCV基因非1型和低HCV RNA载量;获得ETVR的独立影响因素为高ALT水平;获得SVR的独立影响因素为HCV基因非1型、高ALT水平和rs8099917基因TT型。结论 HCV基因非1型、高ALT水平和rs8099917基因TT型是获得SVR的有利因素。
Objective To investigate the influencing factors of the efficacy on virologic response of the standard antiviral therapy in patients with chronic hepatitis C( CHC) and to provide a reference value for clinical treatment. Methods The data of 97 patients with CHC were analyzed retrospectively. The conditions of hepatitis C virus( HCV) genotypes,HCV RNA,and rs8099917 genotypes in interieukin-28B( IL-28B) gene were determined,respectively. The patients were all given the standard antiviral therapy. The influencing factors of rapid virological response( RVR),early virological response( EVR),end-of-treatment virological response( ETVR) and sustained virological response( SVR) were compared and analyzed,respectively. Results The RVR,EVR,ETVR and SVR rates were significant differences in HCV genotype 1 group and in HCV non-genotype 1 group,in rs8099917 genotype TT group and in rs8099917 genotype GT + GG group,respectively( χ2= 9. 359,11. 440,6. 346,8. 147,9. 938,7. 413,4. 564,4. 229; P < 0. 05). The independent impact factors of RVR were HCV non-genotype 1,high levels of ALT and AST,low HCV RNA level,and rs8099917 genotype TT; of EVR were HCV non-genotype 1 and low HCV RNA level; of ETVR was high ALT level; and of SVR were HCV non-genotype 1,high ALT level,and rs8099917 genotype TT. Conclusion HCV non-genotype 1,high ALT level,and rs8099917 genotype TT are important favorable factors for SVR in patients with CHC.
Objective To investigate the influencing factors of the efficacy on virologic response of the standard antiviral therapy in patients with chronic hepatitis C( CHC) and to provide a reference value for clinical treatment. Methods The data of 97 patients with CHC were analyzed retrospectively. The conditions of hepatitis C virus( HCV) genotypes,HCV RNA,and rs8099917 genotypes in interieukin-28B( IL-28B) gene were determined,respectively. The patients were all given the standard antiviral therapy. The influencing factors of rapid virological response( RVR),early virological response( EVR),end-of-treatment virological response( ETVR) and sustained virological response( SVR) were compared and analyzed,respectively. Results The RVR,EVR,ETVR and SVR rates were significant differences in HCV genotype 1 group and in HCV non-genotype 1 group,in rs8099917 genotype TT group and in rs8099917 genotype GT + GG group,respectively( χ2= 9. 359,11. 440,6. 346,8. 147,9. 938,7. 413,4. 564,4. 229; P < 0. 05). The independent impact factors of RVR were HCV non-genotype 1,high levels of ALT and AST,low HCV RNA level,and rs8099917 genotype TT; of EVR were HCV non-genotype 1 and low HCV RNA level; of ETVR was high ALT level; and of SVR were HCV non-genotype 1,high ALT level,and rs8099917 genotype TT. Conclusion HCV non-genotype 1,high ALT level,and rs8099917 genotype TT are important favorable factors for SVR in patients with CHC.
引文
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[2]中华预防医学会医院感染控制分会.中国丙型病毒性肝炎医院感染防控指南[J].传染病信息,2013,26(2):71-75.
[3]程丹颖,闫杰,赵红,等.丙型肝炎病毒基因型和抗病毒治疗病毒学应答的相关性研究[J].中华实验和临床感染病杂志(电子版),2013,7(3):353-356.
[4]窦晓光.影响丙型肝炎初治患者标准化治疗疗效的相关因素及对策[J].中华肝脏病杂志,2013,21(6):406-407.
[5]丁世雄,周文红,胡爱荣,等.宁波地区丙型肝炎病毒基因分型检测[J].中国卫生检验杂志,2011,21(10):2453-2454.
[6]陈园生,李黎,崔富强,等.中国丙型肝炎血清流行病学研究[J].中华流行病学杂志,2011,32(9):888-891.
[7]鲁健,蒋郁青,赵洪兰,等.我国六省市(区)部分人群丙型肝炎病毒感染调查[J].中华实验和临床病毒学杂志,2011,25(6):448-449.
[8]中华人民共和国国家卫生和计划生育委员会.2012年度全国法定传染病疫情概况[EB/OL].(2013-03-15)[2014-08-16].http://www.nhfpc.gov.cn/jkj/s3578/201304/b540269c8e5141e6bb2d00-ca539bb9f7.shtml.
[9]中华人民共和国国家卫生和计划生育委员会.2013年度全国法定传染病疫情概况[EB/OL].(2014-02-13)[2014-08-16].http://www.nhfpc.gov.cn/jkj/s3578/201402/26700e8a83c04205913a10-6545069a11.shtml.
[10]任红.丙型肝炎防治,任重道远[J].中华肝脏病杂志,2013,21(6):401-402.
[11]苏迎盈,刘慧鑫,汪宁.中国丙型肝炎病毒基因型分布[J].中华流行病学杂志,2013,34(1):80-84.
[12]European Association for the Study of the Liver.EASL Clinical Practice Guidelines:management of hepatitis C virus infection[J].J Hepatol,2014,60(2):392-420.
[13]Ghany MG,Nelson DR,Stmder DB,et al.An update on treatment of genotype 1 chronic hepatitis C virus infection:2011 practice guideline by the American Association for the Study of Liver Diseases[J].Hepatology,2011,54(4):1433-1444.
[14]Ge D,Fellay J,Thompson AJ,et al.Genetic variation in IL28B predicts hepatitis C treatment-induced viral clearance[J].Nature,2009,461(7262):399-401.
[15]谢俊强,郭小燕,曹红,等.白细胞介素28B基因多态性与丙型肝炎治疗持续应答的关系[J].中华肝脏病杂志,2012,20(12):892-895.