关键词: 慢性丙型肝炎, 肝硬化, 聚乙二醇干扰素, 长期随访

Abstract: Objective To investigate the effect and clinical outcomes on combination treatment of pegylated interferon alpha-2a and ribavirin (PR) for hepatitis C virus (HCV) genotype 1 patients with compensated cirrhosis.Methods In our parallel retrospective cohort study, HCV genotype 1 patients with HCV related compensated cirrhosis received PR therapy and symptomatic treatment with colony-stimulating factors (CSF). And the patients undertook a long-term follow-up for 5 years. The efficacy and recurrence rate of antiviral therapy were evaluated. Transient elastography (TE) was used in liver stiffness measurement (LSM). The occurrences of clinical events, including hepatic encephalopathy, ascites, gastrointestinal bleeding, hepatocellular carcinoma (HCC) and death, was compared between sustained virological response (SVR) group and non-sustained virological response (NSVR) group. Results Fifty-four HCV genotype 1 patients with HCV related compensated cirrhosis completed the PR therapy, and 34 (64.81%) achieved SVR. Fourteen among 23 patients(65.22%) achieved SVR after the first antiviral therapy, so did 9/14 (64.29%) patients after the second, 8/13 (76.92%) after the third, 2/3 (66.67%) after the forth and 1/1 (100%) after the fifth. Only one case relapsed at 6 weeks after achievement of SVR. During the antiviral treatment period, LSM improved to varying degrees, which showed a significant statistical difference in SVR groups (P=0.0004). During the long-term follow-up, the LSM of SVR group showed a further decline and kept at a low level. However, there was no improvement of LSM in NSVR group. During the follow-up for 60 months on average, there were 3 cases developing HCC in NSVR group, while 0 in SVR group. Incidence of clinical events, such as ascites [P=0.0168, RR=0.2353 (95%CI 0.0390-1.422)] and HCC [P=0.0391, RR=0.0000], between the two groups showed significant difference.Conclusion PR therapy can effectively restrain virus replication for HCV genotype 1 patients with HCV related compensated cirrhosis. Combination therapy with CSF can improve treatment compliance. Patients who failed in the previous treatments can acquire SVR via repeated or extended course of PR treatments. Acquisition of SVR can decrease recurrence rate and occurrence of clinical events, and improve progression of cirrhosis.

Key words: Chronic hepatitis C, HCV-related cirrhosis, Pegylated interferon alpha, Long-term follow-up