慢性丙型肝炎抗病毒治疗快速病毒学应答和早期病毒学应答血液生化影响因素分析

发布时间：2018-01-24 18:24

本文关键词： 慢性丙型肝炎影响因素治疗快速病毒学应答早期病毒学应答　出处：《大连医科大学》2013年硕士论文　论文类型：学位论文

【摘要】：目的：丙型肝炎是因感染丙型肝炎病毒（HCV）引起的传染性肝病。从严重程度看，感染HCV有可能只出现几周轻微的症状，也可能导致终身严重的肝病。全球每年有300~400万人感染HCV，约有1.5亿人患有慢性丙肝，并面临进展为肝硬化和/或肝癌的风险。每年约有35万余人死于与丙肝相关的肝脏疾病。世界各地均存在丙型肝炎。中国是慢性HCV感染率高发的国家之一。已有的研究表明，慢性丙型肝炎患者接受聚乙二醇化干扰素（PEG-IFN）联合利巴韦林（RBV）抗病毒治疗后如果产生快速病毒学应答（RVR）或早期病毒学应答（EVR），将会有很大的几率获得持续病毒学应答（SVR）。本研究的目的是分析接受抗病毒治疗的慢性丙型肝炎患者血常规，肝功等血液生化因素对于获得RVR和EVR的影响，为判断其预后及实施个体化治疗提供依据。方法：选取2009年1月至2012年6月在大连市第六人民医院住院并接受PEG-IFN联合RBV抗病毒治疗的慢性丙型肝炎患者，共94例。PEG-IFN每周180μg，RBV根据体重每日给予800~1200mg。分别在治疗前，治疗第4周和第12周检测HCV RNA，血常规和肝功。根据治疗第4周时能否检测到HCV RNA，将患者分为RVR组和无RVR组，根据治疗第12周时能否检测到HCV RNA，将患者分为完全早期病毒学应答（cEVR）组和无cEVR组。对可能产生RVR和cEVR患者的血细胞和肝功以及其它因素进行回顾性分析。结果：总共94名患者在研究当中，平均年龄为46.93±13.38岁，，63.83%为男性。这些患者中54例（57.45%）获得RVR，79例（84.04%）获得cEVR。获得RVR与未获得RVR者相比，单因素分析中基线病毒载量（HCV RNA1×106IU/ml）与RVR有关（χ2=6.017，P=0.014），经过多因素logistic回归分析，基线病毒载量（OR:3.317;95%CI:1.291to8.521; P=0.013）和治疗前红细胞计数（OR:2.492;95%CI:1.099to5.650; P=0.029）是获得RVR的独立预测因素。获得cEVR与未获得cEVR者相比，单因素分析中丙氨酸氨基转移酶与cEVR有关（P=0.007），经过多因素logistic回归分析，基线病毒载量（OR:5.040;95%CI:1.130to22.481;P=0.034）和治疗前血小板计数（OR:1.018;95%CI:1.002to1.034; P=0.028）是获得cEVR的独立预测因素。重复测量资料分析显示治疗期间血细胞和肝功的变化对是否获得病毒学应答无影响。高血压、糖尿病和脂肪肝与RVR或cEVR无关。天门冬氨酸氨基转移酶与血小板比值指数是被推荐用于衡量肝纤维化的几个指标之一，它对是否获得病毒学应答无影响。结论： 1.治疗前基线病毒载量的高低是获得RVR和cEVR的独立影响因素。低病毒载量者易取得RVR或cEVR。 2.治疗前血常规中的红细胞计数是获得RVR的独立影响因素。红细胞计数高者较低者更易获得RVR。 3.治疗前血常规中的血小板计数是获得cEVR的独立影响因素。血小板计数高者较低者更易获得cEVR 4.治疗过程中血常规，肝功指标的变化，对是否获得病毒学应答无影响。
[Abstract]:Objective: Hepatitis C is an infectious liver disease caused by infection with hepatitis C virus (HCV). In terms of severity, HCV infection is likely to show mild symptoms for only a few weeks. It can also lead to life-long severe liver disease. Between 300 and 4 million people worldwide are infected with HCV each year, and about 150 million people suffer from chronic hepatitis C. And at risk of progression to cirrhosis and / or liver cancer. About 350,000 people die each year from liver disease associated with hepatitis C. Hepatitis C. China is one of the countries with high rates of chronic HCV infection. Existing studies have shown. Patients with chronic hepatitis C received PEG-IFN combined with ribavirin (RBV) as antiviral agents if they developed a rapid virological response (RVR) or an early virological response (RVR) or early virological response (RVR). EVR. The aim of this study was to analyze the blood routine of patients with chronic hepatitis C who received antiviral therapy. The effect of blood biochemical factors such as liver function on obtaining RVR and EVR provides basis for judging the prognosis and implementing individualized treatment. Methods: Patients with chronic hepatitis C who were hospitalized in Dalian 6th people's Hospital from January 2009 to June 2012 and received PEG-IFN combined with RBV antiviral therapy were selected. A total of 94 cases (180 渭 g / week) of PEG-IFN were given 800 ~ 1200mg per day according to body weight. HCV RNA was detected at week 4 and week 12 before treatment, respectively. According to whether HCV RNAs could be detected in the 4th week of treatment, the patients were divided into RVR group and no RVR group, and HCV RNA was detected according to the 12th week of treatment. The patients were divided into two groups: complete early virological response group and no cEVR group. The blood cells, liver function and other factors of patients with RVR and cEVR were analyzed retrospectively. Results: In a total of 94 patients in the study, the average age was 46.93 卤13.38 years old and 63.83% were male. 54 of these patients (57.45) received RVR. RVR was obtained in 79 cases (84.04). The results were compared with those without RVR. In univariate analysis, the baseline viral load was correlated with RVR (蠂 2: 6.017) and RVR (P < 0.014). By multivariate logistic regression analysis, the baseline viral load was OR: 3.317; 95 CI: 1.291 to 8.521; (P < 0.013) and red blood cell count (OR: 2.492) before treatment; 95 CI: 1.099 to 5.650; Pu 0.029) was an independent predictor of RVR, and cEVR was compared with those without cEVR. In univariate analysis, alanine aminotransferase was associated with cEVR. By multivariate logistic regression analysis, the baseline virus load was OR 5.040; 95 CI: 1.130 to 22.481; (P < 0.034) and platelet count (OR: 1.018) before treatment; 95 CI: 1.002 to 1.034; Repeated measurement data analysis showed that changes in blood cells and liver function had no effect on obtaining virological response during treatment. Hypertension. Diabetes and fatty liver are not associated with RVR or cEVR. Aspartate aminotransferase / platelet ratio index is one of the recommended indicators for liver fibrosis. It has no effect on obtaining virological responses. Conclusion: 1. The level of baseline viral load before treatment was an independent factor for obtaining RVR and cEVR, and low viral load was easy to obtain RVR or cEVR. 2. Erythrocyte count in blood routine before treatment was an independent factor in obtaining RVR, and RVRs were more easily obtained in patients with high RBC count than those with lower RBC count. 3. Platelet count in blood routine before treatment is an independent factor in obtaining cEVR. High platelet count is more likely to obtain cEVR than low platelet count. 4. The changes of blood routine and liver function indexes had no effect on obtaining virological response.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R512.63

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