以干擾素或長效型干擾素合併雷巴威林治療慢性C型肝炎時治療終點的病毒學及生化學反應分歧之研究

Discrepancy between Virological and Biochemical Responses at the End of Interferon or Peginterferon plus Ribavirin Treatment for Chronic Hepatitis C Patients

陳君豪(Chun-Hao Chen)

指導教授 ： 余明隆

高雄醫學大學/醫學院/醫學研究所/碩士(2008年)

https://doi.org/10.6832/KMU.2008.00179

摘要

前言: 以干擾素或長效型干擾素合併雷巴威林的治療是目前慢性C型肝炎最有效治療。但是在治療結束時我們偶然會發現其生化學的反應常與病毒學的反應不一致,目前對於這兩個反應不一致的現象其發生率,結果及影響因子都不清楚。
研究目的: 找出會影響反應不一致的臨床因子,並評估其發生率,及對臨床治療是否有影響。
病人及研究方法: 從1998.8至2005.10,共有496位病人(其中301位男性,195位女性)接受傳統干擾素或長效型干擾素合併雷巴威林的治療來參與本研究。
結果: 在達到治療結束病毒學反應(EOTVR)的478位病人中,有137位(28.7%)病人在治療結束時有生化學反應不一致的現象。反應一致的病人,其持續的病毒學反應(SVR)比率(81.2%,277/341)與反應不一致的病人的持續病毒學反應比率(75.2%,103/137)是相似的(p=0.14)。 在單變項分析中,有以下因子和兩反應的不一致呈正相關:年紀大,肥胖,嚴重的肝臟發炎或纖維化,肝臟內的脂肪堆積,較少的病毒量,長效型干擾素的使用以及較高的雷巴威林劑量等。若使用多變項分析, 則發現若肝纖維化嚴重,肝內有脂肪堆積,肥胖,年紀大,長效型干擾素的使用及較少的病毒量都與兩反應的不一致性有關。
結論:我們發現C型肝炎病人若接受干擾素合併雷巴威林的治療,會有28.7%的病人有病毒學及生化學反應不一致的現象,但這不會影響其治療的持續性病毒反應(SVR)。另外,若肝纖維化嚴重,肝內有脂肪堆積,肥胖,年紀大,長效型干擾素的使用及較少的病毒量的病人較容易有病毒學與生化學反應的不一致。

關鍵字

C型肝炎 ； 干擾素 ； 生化學反應 ； 病毒學反應 ； ALT ； 臨床因子 ； 長效型干擾素 ； 雷巴威林 ； 治療

並列摘要

BACKGROUND: Discrepancy of biochemical and virological responses may occur during interferon or peginterferon (Peg-IFN) plus ribavirin combination therapy for chronic hepatitis C (CHC). However, the incidence and outcome of the phenomenon, as well as factors associated with the phenomenon remains unclear.
AIMS: To assess the incidence and outcome of, and clinical factors associated with biochemical and virological discrepancy in (Peg-)IFN/ribavirin treatment for CHC.
PATIENTS AND METHODS: 496 patients (301 men, 195 women) treated with IFN or Peg-IFN plus ribavirin between August 1998 and October 2005 were included. Discrepancy of virological and biochemical response was defined as patients who achieved an end-of-treatment virological response (EOTVR), but did not achieve an end-of-treatment biochemical response (EOTBR).
RESULTS: Of 478 patients who achieved an EOTVR, 137 (28.7%) patients had biochemical discrepancy during and at the end of treatment. Among patients with EOTVR, the rate of sustained virological response (SVR) was similar between patients with biochemical discrepancy (75.2%, 103/137) and those without biochemical discrepancy (81.2%, 277/341). In univariate analysis, older age, obesity (BMI>25), severe hepatic inflammation, advaced fibrosis, hepatic steatosis, low viral load, PEG-interferon preparation, and ribavirin dosage were associated with the discrepancy. Using multivariate analysis, advanced hepatic fiborsis, hepatic steatosis, obesity, older age, PEG-IFN preparation and low viral load were positively predictive of biochemical discrepancy among patients with EOTVR.
CONCLUSIONS: We demonstrated that 28.7% CHC patients with EOTVR had biochemical discrepancy during (Peg-)IFN/ribavirin therapy. The discrepancy did not correlate the treatment outcome. Advanced hepatic fiborsis, hepatic steatosis, obesity, older age, PEG-IFN preparation and low viral load were positively predictive of biochemical discrepancy.

並列關鍵字

hepatitis C ； interferon ； PEG-interferon ； ALT ； biochemical ； virological ； clinical factors ； ribavirin ； treatment

參考文獻

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