Objective To compare the clinical efficacy of IL28B genotype-guided individualized regimen and standardized antiviral therapy in the treatment of chronic hepatitis C. Methods A total of 60 patients with chronic hepatitis C, who admitted to the Second People's Hospital of Chenzhou from March 2012 to September 2014, were selected and divided into the individualized treatment group and the standardized treatment group according to random number table method, with 30 cases in each group. The HCV RNA genotype and IL28B genotype were examined before the treatment. The standardized treatment group was treated with peginterferon (Peg-IFN)α-2a combined with ribavirin (RBV), lasting for 48 weeks, and the viral load during the treatment was measured. The treatment method for the individualized treatment group was adjusted on the basis of IL28B genotyping treatment, and the course of IL28B gene non-CC type patients was prolonged to 72 weeks. The antiviral efficacy and treatment safety were compared between the two groups. Results The obtained rates of the rapid virological response (RVR), early virological response (EVR), delayed virological response (DVR), end of treatment virological response (ETVR), sustained virological response (SVR) in the individualized treatment group were slightly higher than those in the standardized treatment group, and the recurrence rate was slightly lower than that in the standardized treatment group, without significant difference between the two groups (P>0.05). There was no significant difference in the obtained rates of SVR between the HCV genotype 1 patients and non-HCV genotype 1 patients in the standardized treatment group (P>0.05), but there was significant difference in the obtained rates of SVR between the IL28 genotyping of CC and non-CC patients (P<0.05);In the individualized treatment group, there was no significant difference in the obtained rates of SVR between HCV genotype 1 and non-HCV genotype 1, and between IL28 genotype CC patient and non-CC patients (P>0.05). The obtained rates of non-HCV genotype 1 patients and IL28 genotype 1 non-CC patients were significantly higher than those in the standardized treatment group (P<0.05). There was no significant difference in the incidence rate of adverse reactions between the standardized treatment group and the individualized treatment group during the treatment (30.0%vs 20.0%, P>0.05). Conclusion Host IL28B genotype has an important impact on the treatment efficacy of Peg-IFN combined with RBV antiviral individualized therapy in patients with chronic hepatitis C. It can be used as an important predictor of SVR before the treatment.%目的 比较IL28B基因型指导下个体化方案与标准化抗病毒治疗慢性丙型肝炎的临床疗效.方法 选取郴州市第二人民医院2012年3月至2014年9月期间收治的60例慢性丙型肝炎患者,采用随机数表法分为个体化治疗组和标准化治疗组,每组30例.治疗前均查HCV RNA基因分型和IL28B基因分型,标准化治疗组采取聚乙二醇干扰素(Peg-IFN)α-2a联合利巴韦林(RBV)治疗方案,治疗为48周,治疗期间查病毒载量;个体化治疗组在IL28B基因分型基础上调整治疗方法,对IL28B基因非CC型的患者适当将疗程延长至72周.比较两组患者的抗病毒疗效和治疗安全性.结果 个体化治疗组患者快速病毒学应答(RVR)、早期病毒学应答(EVR)、延迟病毒学应答(DVR)、治疗结束时病毒学应答(ETVR)、持续病毒学应答(SVR)获得率略高于标准化治疗组,复发率略低于标准化治疗组,但差异均无统计学意义(P>0.05);标准化治疗组中,HCV基因1型、非1型患者的SVR获得率比较差异无统计学意义(P>0.05),但IL28基因分型CC型、非CC型患者的SVR获得率比较差异有统计学意义(P<0.05);个体化治疗组中,HCV基因1型、非1型患者的SVR获得率比较以及IL28基因CC型、非CC型患者的SVR获得率比较差异均无统计学意义(P>0.05);个体化治疗组中HCV基因非1型、IL28基因非CC型患者的SVR获得率均明显高于标准化治疗组,差异均有统计学意义(P<0.05).治疗过程中,标准化治疗组、个体化治疗组患者不良反应发生率分别为30.0%和20.0%,差异无统计学意义(P>0.05).结论 IL28B基因分型能够影响慢性丙型肝炎患者的抗病毒治疗效果,而宿主IL28B基因指导下的个体化方案治疗疗效较标准方案突出,患者耐受性好.
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