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目的探讨个体化剂量聚乙二醇干扰素α-2b(佩乐能)联合利巴韦林抗病毒治疗代偿期丙型肝炎肝硬化患者的有效性、安全性及耐受性。方法选择2013年5月~2015年4月珠海市人民医院门诊及住院的20例符合抗病毒条件的丙型肝炎肝硬化代偿期患者,应用个体化剂量(每周50~100μg)聚乙二醇干扰素α-2b联合利巴韦林(每日800~1 200 mg)进行24~72周治疗,检测治疗过程中丙型肝炎病毒核酸定量(HCV-RNA)等指标,回顾性选择同期未进行抗病毒治疗的代偿期丙肝肝硬化患者10例为对照组。结果治疗组治疗中达到快速病毒学应答(RVR)者50.0%(10/20),进一步治疗达到早期病毒学应答(EVR)者80.0%(16/20),治疗结束后达到持续病毒学应答(SVR)者70.0%(14/20),无应答(NR)者10.0%(2/20)治疗疗程均少于4周,复发(RR)者10.0%(2/20)HCV亚型均为1 b型;对照组无HCV-RNA转阴(0%),其中40%(4/10)进展至失代偿期肝硬化,20%(2/10)合并原发性肝癌。结论佩乐能联合利巴韦林个体化抗病毒治疗对代偿期丙肝肝硬化有确切疗效,可使大部分患者实现持续性病毒学应答,控制和缓解病情。在现阶段,也使部分需要直接抗病毒药物(DAAs类)治疗的患者通过本方案治疗控制肝硬化向失代偿期发展,以等待药物在我国上市后使用,起到积极的治疗作用。
Objective To investigate the efficacy, safety and tolerability of the individualized dose peginterferon alfa-2b (PegIntron) combined with ribavirin antiviral therapy in decompensated patients with hepatitis C cirrhosis. Methods From May 2013 to April 2015, 20 patients with hepatitis C cirrhosis who were outpatient and hospitalized in Zhuhai People ’s Hospital were enrolled in this study. Individualized dose (50 ~ 100μg per week) Interferon alfa-2b combined with ribavirin (800 ~ 1 200 mg daily) for 24 to 72 weeks of treatment, detection of hepatitis C virus during treatment of nucleic acid quantitative (HCV-RNA) and other indicators, retrospectively choose the same period 10 patients with decompensated hepatitis C cirrhosis who underwent antiviral therapy were the control group. Results 50.0% (10/20) of the patients in the treatment group achieved rapid virological response (RVR), 80.0% (16/20) in the further treatment to achieve early virological response (EVR), and achieved sustained virological response after the end of treatment SVR) were 70.0% (14/20), no response (NR) 10.0% (2/20) were less than 4 weeks and those with relapse (RR) 10.0% (2/20) The control group had no negative HCV-RNA (0%), of which 40% (4/10) progressed to decompensated cirrhosis and 20% (2/10) had primary liver cancer. Conclusion PegIntron combined with ribavirin individualized antiviral therapy has the exact effect on decompensated hepatitis C cirrhosis, which can make the majority of patients achieve sustained virological response, control and alleviate the disease. At this stage, some patients who need treatment with direct antiviral drugs (DAAs) also control the development of cirrhosis to decompensation through this regimen, awaiting the drugs to be used after the listing in our country and playing a positive therapeutic role.