慢性丙型肝炎抗病毒治疗后患者体内持续病毒学应答率影响因素分析

摘要

目的 观察一线抗病毒药物治疗后慢性丙型肝炎(CHC)患者获得持续病毒学应答(SVR)的影响因素.方法 对71例CHC患者予—线抗病毒药物治疗,随访48周,观察疗效;分别应用单因素分析及多因素Logistic逐步回归分析方法,分析患者年龄、性别、HCV基因型、基线血清HCV-RNA定量、外周血单个核细胞(PBMC)内HCV-RNA表达、肝纤维化程度、肝脂肪变性、肝组织瘦素表达及治疗过程中快速病毒学应答(RVR)、早期病毒学应答(EVR)等因素与SVR的关系.结果 71例均完成48周疗程,其中59例(83.1％)获得RVR、64例(90.1％)获得EVR、67例(94.3％)获得治疗结束时病毒学应答(ETVR)、4例无病毒学应答,67例获得ETVR患者的SVR率随访24周时为82.1％、48周时为73.1％.年龄≥50岁、HCV基因I型、基线血清HCV-RNA高载量、PBMC内HCV-RNA表达阳性、肝纤维化≥S2及肝组织瘦素表达阳性患者的SVR率明显降低,而性别、传播途径、肝脂肪变性及治疗过程中RVR、EVR与治疗后SVR率无明显相关;HCV基因I型是影响停药24周SVR率的独立危险因素,CHCV基因I型、PBMC内HCV-RNA阳性及外周血HCV-RNA高载量是影响停药48周SVR率的独立危险因素.结论 HCV基因I型、PBMC内HCV-RNA表达阳性、基线血清HCV-RNA高载量是CHC患者抗病毒治疗停药48周后SVR率的独立危险因素.%Objective To investigate potential predictive factors associated with sustained virological response to firstline antiviral drugs in patients with chronic hepatitis C virus (HCV) infection.Methods Seventy-one patients with chronic hepatitis C (CHC) were treated with first-line antiviral drugs.Information for the patients was recorded in detail,including age,sex,route of transmission,HCV genotype,baseline HCV RNA level,expression of HCV RNA in PBMC,hepatic fibrosis,steatosis,leptin expression in liver tissue and RVR,EVR.Univariate analysis and multivariate logistic stepwise regression analysis were used for analysis between the above factors and SVR.Results In 71 patients,59 cases (83.1％) achieved RVR,64 cases (90.1％) achieved EVR and 67 cases (94.3％) achieved ETVR,4 cases without virological response.The rates of SVR in 67 cases achieving EIVR were 82.1％ in 24-week-follow-up and 73.1％ in 48-week-follow-up.Univariate analysis showed that the rate of SVR was lower for age ≥50,genotype I,HCV RNA ≥ 1.0 × 105copies/mL,HCV RNA in PBMC positive,liver fibrosis ≥ S2 and leptin expression positive than for age ＜ 50,genotype non-I,HCV RNA ＜1.0 × 105copies/mL,HCV RNA in PBMC negative,liver fibrosis ＜ S2 and leptin expression negative.There was no relationship between the rate of SVR and sex,route of transmission,steatosis,RVR,EVR.Multivariate logistic stepwise regression analysis showed that HCV genotype I was an independent risk factor for SVR in withdrawal of antiviral therapy for 24 weeks.CHCV genotype I,HCV RNA positive in PBMC and high HCV RNA level were independent risk factors for 48 weaks.Conclusion Genotype I,baseline HCV RNA high load and HCV RNA positive in PBMC were independent risk factors for SVR in patients with CHC withdrawal of antiviral therapy for 48 weeks.