- 期刊
慢性C型肝炎標準照顧在臨床上的療效：南台灣醫學中心某醫師的經驗
Treatment Effects of Standard of Care for Chronic Hepatitis C in Real World: A Personal Experience of a Hepatologist in a Medical Center in Southern Taiwan
摘要
慢性C型肝炎在台灣的盛行率約4.4%，高盛行率地區可達24~90%。以長效型干擾素(peginterferon alpha 2a/2b)合併抗病毒藥物雷巴威林(ribavirin)來治療，已是目前的標準照顧(standard of care; SOC)。目的：從一般內科醫師的觀點，我們必須了解慢性C型肝炎的SOC是一種高成功率與低中斷治療率(low withdraw rate)的處置，臨床上能夠依照治療指引轉介符合治療標準的病例給肝膽腸胃科醫師予以積極的處理。我們採回溯性方法從94年1月1日至98年10月31日之間，在台灣南部某醫學中心由盧醫師以SOC，共治療222位慢性C型肝炎病患，排除了非屬第一型或第二型基因型的12例，與在治療結束後仍未做HCV RNA檢測而無法評估其持續性病毒反應(sustained virological response; SVR)的8例後，以百分比來做統計分析。實際接受SOC的病患是202例，其中有12例(6%)因無法忍受治療的副作用而退出，最終有190例接受SOC。其中未曾治療過的病人有157例，有接受干擾素治療過再次接受SOC有33例，而基因型第一型中未曾治療過的病人，經接受SOC而有SVR者是43例(56%)，有接受干擾素治療過再次接受SOC而有SVR者是15例(48%)。在第二型的病人的結果依次是70例(88%)與2例(100%)。從臨床的研究中，在這真實世界裡，標準照顧對慢性C型肝炎病患是有效的治療。一般內科醫師應轉介符合標準照顧的慢性C型肝炎病患給肝膽腸胃科醫師，以降低慢性C型肝炎患者發展成肝硬化與肝癌的危險。
並列摘要
In Taiwan, prevalence of chronic hepatitis C virus (HCV) infection was 4.4%. But it could be 24% to 90% in some endemic areas. Combination therapy of peginterferon alpha 2a/2b plus ribavirin is the current standard of care (SOC) for patients with chronic HCV (CHC). Objectives: From the viewpoint of General Medicine (GM) physicians, we should recognize that SOC for CHC patients was a therapy with high sustained virological response (SVR) rate and low withdraw rate. To elucidate the therapeutic benefit of SOC in real world, the experience for CHC treatment by a hepatologist was analyzed. From Jan 2005 to October 2009, 222 CHC patients underwent SOC by a hepatologist in a medical center in southern Taiwan were studied. Those who infected with genotypes other than genotype 1(G1) or genotype 2(G2) (n=12) or not tested for HCV RNA after end of treatment (n=8) were excluded. We enrolled 202 cases into analysis. Twelve (6%) patients quitted therapy for intolerable side effects. Among the 190 patients with completed treatment, 157 cases were naïve patients and 33 cases were retirement patients. The sustain virological response (SVR) rate was 56% and 88% for G1 and G2 naïve patients, and 48% and 100% for retreatment patients, respectively. This clinical observation showed that the SOC for CHC patients was effective method in real world. The General Medicine physicians should transfer CHC patients who meet criteria of SOC to hepatologist for decreasing the risk of development of liver cirrhosis and hepatocellular carcinoma in CHC patients.