聚乙二醇干扰素联合利巴韦林治疗静脉药瘾致慢性丙型肝炎患者的疗效评价

摘要/Abstract

摘要： 目的评价静脉药瘾致慢性丙型肝炎患者接受聚乙二醇干扰素联合利巴韦林抗病毒的疗效及安全性。方法回顾性纳入静脉药瘾致慢性丙型肝炎患者51例,以病毒学应答、复发率为疗效评价指标,并分析可能影响此类患者获得持续病毒学应答(sustained virologic response,SVR)的因素。结果 ①静脉药瘾致慢性丙型肝炎患者中位年龄32.5岁;男性占92.2%(47/51);HCV基因3型占52.9%(27/51)。②本组患者获得快速病毒学应答(rapid virologic response, RVR),早期病毒学应答(early virologic response, EVR),治疗结束病毒学应答(end-of-treatment virologic response, ETVR),SVR几率分别为66.7%、58.8%、60.8%、41.2%,复发率为32.3%。合并酒精性肝病患者获得SVR几率明显低于无酒精性肝病者(P=0.036)。③Logistic多因素分析显示静脉药瘾戒断时间每延长1个月,获得SVR几率增加1.365倍(P=0.004);获得ETVR的静脉药瘾致慢性丙型肝炎患者获得SVR的几率是未获得ETVR者的8.885倍(P=0.018)。结论静脉药瘾致慢性丙型肝炎患者以年轻男性多见,基因3型患者占50%以上;接受聚乙二醇干扰素联合利巴韦林抗病毒可获得相对较高的病毒学应答率,静脉药瘾戒断时间与ETVR是此类患者获得SVR的影响因素。

关键词: 丙型肝炎,慢性, 静脉药瘾者, 聚乙二醇干扰素, 利巴韦林, 持续病毒学应答

任晓静,季媛媛,戚勋,徐国光. 聚乙二醇干扰素联合利巴韦林治疗静脉药瘾致慢性丙型肝炎患者的疗效评价[J]. 肝脏, 2017, 22(6): 529-531.

参考文献 18

[1]	Omata M, Kanda T, Yu ML, et al. APASL consensus statements and management algorithms for hepatitis C virus infection,Hepatol Int,2012,6:409-435.
[2]	European Association for the Study of the Liver. EASL Clinical Practice Guidelines:management of hepatitis C virus infection. J Hepatol, 2011, 55: 245-264.
[3]	Seeff LB. The history of the “natural history” of hepatitis C (1968-2009). Liver Int, 2009, 29(suppl 1):89-99.
[4]	Hahn JA, Page-Shafer K, Lum PJ, et al. Hepatitis C virus infection and needle exchange use among young injection drug users in San Francisco. Hepatology,2001,34: 180-187.
[5]	Thomas DL, Vlahov D, Solomon L, et al. Correlates of hepatitis C virus infections among injection drug users. Medicine (Baltimore), 1995, 74: 212-220.
[6]	Vidal-Trécan G, Coste J, Varescon-Pousson I, et al. HCV status knowledge and risk behaviours amongst intravenous drug users. Eur J Epidemiol,2000,16: 439-445.
[7]	Xia X, Luo J, Bai J, et al. Epidemiology of hepatitis C virus infection among injection drug users in China: systematic review and meta-analysis. Public Health,2008,122: 990-1003.
[8]	骆峻,夏娴,喻荣彬. 静脉注射吸毒人群丙型肝炎病毒感染研究进展. 世界华人消化杂志,2007,15:2966-2971.
[9]	中华医学会传染病与寄生虫病学分会、肝病学分会. 病毒性肝炎防治方案. 中华肝脏病杂志, 2000, 8: 324-329.
[10]	中华医学会肝病学分会、中华医学会传染病与寄生虫病学分会. 丙型肝炎防治指南. 中华肝脏病杂志,2004, 12: 194-198.
[11]	施平,唐卫明,李雷,等. 吸毒人群中丙型肝炎病毒感染状况调查分析. 南京医科大学学报(自然科学版),2009,29:1407-1409,1414.
[12]	邹华,骆宗仪,严冰. 678例吸毒人群丙型肝炎病毒感染状况分析. 广西医学,2014,36:680-681.
[13]	Ghany MG, Strader DB, Thomas DL, et al. Diagnosis, management, and treatment of hepatitis C: an update. Hepatology,2009,49: 1335-1374.
[14]	孟庆颖,徐有青. 丙型肝炎与酒精性肝病. 实用肝脏病杂志,2008,11:272-274.
[15]	陈建,王敏,李延青,等. 酒精对慢性丙型肝炎患者的影响. 中华肝脏病杂志,2003,11:624-625.
[16]	Vento S, Cainelli F. Does hepatitis C virus cause severe liver disease only in people who drink alcohol Lancet Infect Dis,2002,2: 303-309.
[17]	Takimoto M, Ohkoshi S, Ichida T, et al. Interferon inhibits progression of liver fibrosis and reduces the risk of hepatocarcinogenesis in patients with chronic hepatitis C: a retrospective multicenter analysis of 652 patients. Dig Dis Sci,2002,47: 170-176.
[18]	Davis GL, Wong JB, McHutchison JG, et al. Early virologic response to treatment with peginterferon alfa-2b plus ribavirin in patients with chronic hepatitis C,Hepatology, 2003,38:645-652.