目的 探讨聚乙二醇干扰素α(PEG-IFN α)联合利巴韦林治疗复发慢性丙型肝炎(CHC)患者的应答情况及影响因素.方法 30例经IFN-α或PEG-IFN α标准RGT治疗后复发的CHC患者,均用PEG-IFN α-2a(180μg)或PEG-IFNα-2b(1.5 μg/kg)联合利巴韦林(900mg/d)再治疗,基因1型治疗48周,非基因1型治疗24周,停药随访24周,分析病毒基因型、基线HCV RNA载量、初治药物种类对联合治疗疗效的影响.结果 30例复发患者经联合再治疗后,24例(80%)获得持续病毒学应答(SVR).18例低病毒载量(HCV RNA≤105拷贝/ml)患者中,17例(94.4%)获得SVR,与高病毒载量组(58.3%)差异有统计学意义(P=0.026).基因1型组18例,其中14例(77.8%)获得SVR,与非基因1型组(83.3%)差异无统计学意义(P=1.000).初治应用PEG-IFNα联合利巴韦林抗病毒的患者17例,其中13例(76.5%)经再治疗后获得SVR,与初治应用妹IFN-α抗病毒组(84.6%)无明显差异(P=0.672).结论 PEG-IFNα联合利巴韦林治疗复发CHC患者的疗效较好.基线病毒载量高,再治疗效果差;病毒基因型及初治所采用的IFN类型与再治疗的疗效无显著相关性.%Objective To assess the effectiveness and to investigate the influencing factors of pegylated interferon α-2a/2b(PEGIFNα-2a/2b) and ribavirin retreatment in patients with chronic hepatitis C(CHC) after initial course of IFN or PEG-IFNα-2a/2b plus ribavirin therapy.Methods A retrospective study was designed to analyze retreatment with IFN or PEG-IFNα-2a/2b plus ribavirin of 30 relapsed CHC patients.All of them received PEG-IFNα-2a at a dose of 180μg/week or PEG-IFNα-2b 1.5μg·kg-1·week-1 and ribavirin at a dose of 900mg/day for 24 or 48 weeks depending on the HCV genotype.The main parameter to evaluate the effectiveness was sustained virologic response(SVR) rate.The influences of HCV RNA load at the baseline, genotype and previous drug categories on response to IFN were analyzed.Results The SVR rate was 80％ for all the patients.The SVR rate of the patients with low viral loads(HCV RNA≤ 1 × 105copies/ml) was markedly higher than that of the patients with high viral loads(HCV RNA＞1 × 105copies/ml)( 94.4％ and 58.3％, P=0.026).The HCV genotype and previous drug categories did not affect the likelihood of SVR although this may be the result of the relatively small number of patients.Conclusion Relapse after previous IFN or PEGIFNα-2a/2b plus ribavirin therapy is associated with a strong probability of treatment success.Baseline serum HCV RNA load is a predictive parameter of SVR.
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