老年慢性丙型肝炎患者抗病毒疗效及影响因素分析

摘要

目的 探讨老年慢性丙型肝炎患者抗病毒疗效的影响因素.方法 回顾性分析48例慢性丙型肝炎患者的临床资料,16例年龄≥60岁患者为老年组,32例年龄＜60岁患者为中青年组.均给予干扰素联合利巴韦林联合抗病毒治疗,记录2组患者病毒学应答、生化学应答及不良反应发生情况,分析影响抗病毒疗效的可能因素.结果 老年组达快速病毒学应答(RVR)、早期病毒学应答(EVR)、持续病毒学应答(SVR)者分别占93.75％ (15/16)、100.00％ (16/16)、50.00％ (8/16),中青年组达RVR、EVR、SVR者分别占90.63％ (29/32)、100.00％ (32/32)、78.13％ (25/32),2组达SVR情况比较差异有统计学意义(P＜0.05).老年组中发生乏力、中性粒细胞减少和贫血的患者比例均明显高于中青年组[93.75％ (15/16)比59.38％(19/32),87.50％ (14/16)比53.13％ (17/32),56.25％ (9/16)比21.88％ (7/32)],2组比较差异有统计学意义(均P＜0.05).2组生化学应答和其他不良反应发生情况比较差异均无统计学意义(P＞0.05).中青年患者和使用长效干扰素联合利巴韦林抗病毒治疗的患者中达到SVR者明显多于老年患者和使用普通干扰素联合利巴韦林抗病毒治疗的患者[78.12％ (25/32)比50.00％(8/16),80.00％(28/35)比38.46％(5/13)] (P ＜0.05).结论 老年慢性丙型肝炎患者SVR率明显下降,不良反应的发生率高.年龄和治疗方案的选择与慢性丙型肝炎患者抗病毒治疗效果有关.%Objective To compare the antiviral treatment situation between the elderly and young chronic hepatitis C (CHC) patients,and to discuss the influence factors of antiviral outcome in patients with chronic hepatitis C.Methods We retrospectively investigated 48 cases of chronic hepatitis C patients.They were divided into elderly patients (≥60 years,n =16) and young patients (＜60 years,n =32).After interferon plus ribavirin combination antiviral therapy,we observed virological response,biochemical response and adverse effects incidence in the two groups,and analyzed the antiviral outcome of possible factors.Results The rates of rapid virological response (RVR),early virological response (EVR) and sustained virological response (SVR) were 93.75％ (15/16),100.00％ (16/16),50.00％ (8/16)respectively in elderly patients.The rates of RVR,EVR and SVR were 90.63％ (29/32),100.00％ (32/32),78.13％ (25/32) respectively in young patients.There were significant differences in SVR rate between the two groups (P ＜ 0.05).Compared with the younger patients,the incidence of fatigue,neutropenia and anemia increased in elderly patients [93.75％ (15/16) vs 59.38％ (19/32),87.50％ (14/16) vs 53.13％ (17/32),56.25％ (9/16) vs 21.88％ (7/32)] (P ＜0.05).There were no significant differences in biochemical response and other adverse effects incidence between the two groups (P ＞ 0.05).The SVR rates and peg-interferon plus ribavirin antiviral treatment in young patients were higher than elderly patients and ordinary interferon plus ribavirin antiviral treatment patients respectively [78.12％ (25/32) vs 50.00％(8/16),80.00％ (28/35)vs 38.46％ (5/13)] (P ＜ 0.05).Conclusions The SVR rate of elderly CHC patients decreases significantly and the adverse effects incidence is high.The age and treatment options are related to antiviral outcome in patients with chronic hepatitis C.