目的分析比较慢性丙型肝炎初治和复治患者细胞因子水平,并探讨其与疗效间的关系.方法选取慢性丙型肝炎初治患者37例和复治患者24例,均接受聚乙二醇干扰素α-2a联合利巴韦林治疗,动态留取标本并检测细胞因子变化,分析其与疗效的关系.11例健康者作为对照组.结果与初治患者能获得较早的病毒学应答相比,复治组12例(50%)在治疗48周时才获得病毒学应答.初治组白细胞介素-4、干扰素(interferon,IFN) γ、CCL-3(MIP-1a)显著高于复治组(P=0.005);初治组粒细胞集落刺激因子水平则低于复治组(P＜0.05).在基线和治疗4周时,初治组较高的IFN γ水平与HCV清除率相关.结论复治患者能否获得治疗成功与宿主免疫应答相关,IFN γ可能是病毒学应答的重要预测因子.%Objective To analyze and compare cytokine levels in treatment-naive and -experienced patients with chronic HCV infection, and to investigate correlation between those immunological factors and antiviral therapy efficacy. Methods Thirty-seven treatment-naive and 24 treatment-experienced patients with chronic HCV infection received combination therapy with pegylated in terferon alfa-2a and ribavirin. Samples was collected dynamically to detect the changes of cytokine levels and the correlation be tween cytokine levels and therapeutic efficacy was analyzed. Eleven healthy donors were recruited as the controls. Results Twelve (50%) treatment-experienced patients with chronic HCV infection achieved a delayed and slow virological response after 48 weeks of combination therapy compared with treatment-naive patients, who had an early and fast virological response. The levels of interleu kin-4, interferon (IFN) γ and CCL-3 (MIP -1a) were significantly higher in treatment-naive patients than those in treatment experienced patients (P=0.005), while the level of granulocyte colony-stimulating factor in treatment-naive patients was lower than that in treatment-experienced patients (P<0.05). Higher IFN γ levels at baseline and week 4 were associated with HCV clearance in treatment-naive patients. Conclusions A successful retreatment in treatment-experienced patients appears to be correlated with the host immune response. IFN γ may be a potential predictor for virological response.
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