慢性丙型肝炎患者抗病毒治疗中肝功能与病毒学应答的关系

发布时间：2018-06-04 02:45

本文选题：肝炎 + 慢性　；参考：《吉林大学学报(医学版)》2016年01期

【摘要】：目的:观察干扰素α2b(INF-α2b)联合利巴韦林治疗慢性丙型肝炎(CHC)患者肝功能变化的特点,探讨不同病毒学应答模式与肝功能的关系。方法:选取CHC患者264例,给予INF-α2b500万U,隔日1次皮下注射;利巴韦林15 mg·kg-1,每日1次口服,疗程48周。检测不同时间点(基线,治疗12、24、48和72周)患者HCV RNA定量和肝功能等指标。根据转归情况,将患者分为持续病毒学应答(SVR)组、治疗中反弹组、复发组和无应答组,比较4组患者治疗前后肝功能的变化及与应答的关系。结果:264例患者中171例(64.8%)获得SVR,37例(14.0%)治疗中反弹,47例(17.8%)复发,9例(3.4%)无应答。与治疗中反弹组比较,基线丙氨酸氨基转移酶(ALT)水平轻度升高的患者较ALT正常的患者易获得SVR(P0.05)。经抗病毒治疗,4组患者血清ALT和天冬氨酸氨基转移酶(AST)均下降,且12周时下降最明显,与治疗前比较差异有统计学意义(P0.05)。治疗中反弹组患者在48周时ALT和AST回升,复发组患者停药后24周时ALT和AST回升,直至停药后24周SVR组患者的ALT和AST可维持稳定。与治疗中反弹组比较,SVR组患者在12周时ALT和AST下降更明显,与治疗前比较差异有统计学意义(P0.05)。在抗病毒治疗过程中,无应答组患者血清ALT和AST水平始终高于SVR组、复发组和治疗中反弹组(P0.05)。与治疗前比较,SVR组患者在12周时总胆红素(TBIL)和直接胆红素(DBIL)水平较其他时间点明显下降(P0.05),直至停药后24周可以维持稳定。在治疗24周时,无应答组患者血清TBIL、DBIL水平明显高于SVR组和治疗中反弹组患者(P0.05)。结论:CHC患者基线ALT水平可能与病毒学应答有关。CHC患者抗病毒治疗后肝功能改善,尤其SVR患者改善更明显,随着病毒的复发或反弹,转氨酶会再次升高。
[Abstract]:Objective: to observe the changes of liver function in patients with chronic hepatitis C (CHCC) treated with interferon 伪 2b INF- 伪 2b) combined with ribavirin, and to explore the relationship between different virological response models and liver function. Methods: 264 patients with CHC were given subcutaneous injection of INF- 伪 2b500 once every other day, ribavirin 15 mg kg -1 daily for 48 weeks. HCV RNA quantification and liver function were measured at different time points (baseline, 12 weeks, 24 weeks and 72 weeks). According to the outcome, the patients were divided into three groups: persistent virological response (SVR) group, rebound group, relapse group and non-response group. The changes of liver function and their relationship with response before and after treatment were compared. Results 171 cases (64.8%) got SVRN (37 cases 14.0) in treatment, 47 cases rebounded (17.8%) and 9 cases (3.4%) did not respond. Compared with the rebound group, patients with slightly elevated baseline alanine aminotransferase (alt) levels were more likely to obtain SVRP-0.05 than those with normal ALT. The levels of serum ALT and aspartate aminotransferase (AST) in the 4 groups treated with antiviral therapy were all decreased, and the decrease was most obvious at 12 weeks after treatment, the difference was statistically significant compared with that before treatment (P 0.05). In the rebound group, ALT and AST increased at 48 weeks, and ALT and AST increased at 24 weeks after withdrawal in the relapse group, until ALT and AST remained stable in the SVR group 24 weeks after the withdrawal. Compared with the rebound group, the ALT and AST decreased significantly at 12 weeks, and the difference was statistically significant compared with that before treatment (P 0.05). In the course of antiviral therapy, the levels of serum ALT and AST in the non-response group were always higher than those in the SVR group, and the levels of serum ALT and AST in the recurrent group and the rebound group during the treatment were higher than those in the SVR group. The levels of total bilirubin TBILand direct bilirubin in SVR group were significantly lower than those at other time points before treatment, and remained stable 24 weeks after withdrawal. After 24 weeks of treatment, the serum levels of TBIL-DBIL in the non-response group were significantly higher than those in the SVR group and the rebound group (P 0.05). Conclusion the level of baseline ALT may be related to the virological response. The liver function is improved after antiviral therapy, especially in SVR patients. With the recurrence or rebound of the virus, the transaminase level will increase again.
【作者单位】：吉林大学第一医院肝胆胰内科;
【基金】：国家自然科学基金资助课题(81072347);国家自然科学基金青年基金资助课题(81200289)
【分类号】：R512.63

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