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      标题:IL28B基因型指导下个体化方案与标准化抗病毒治疗慢性丙型肝炎疗效比较
      作者:谷斌    (郴州市第二人民医院肝病科,湖南 郴州 423000)
      卷次: 2018年29卷10期
      【摘要】 目的 比较 IL28B基因型指导下个体化方案与标准化抗病毒治疗慢性丙型肝炎的临床疗效。方法 选取郴州市第二人民医院2012年3月至2014年9月期间收治的60例慢性丙型肝炎患者,采用随机数表法分为个体化治疗组和标准化治疗组,每组30例。治疗前均查HCV RNA基因分型和 IL28B基因分型,标准化治疗组采取聚乙二醇干扰素(Peg-IFN) α-2a联合利巴韦林(RBV)治疗方案,治疗为48周,治疗期间查病毒载量;个体化治疗组在 IL28B基因分型基础上调整治疗方法,对 IL28B基因非CC型的患者适当将疗程延长至72周。比较两组患者的抗病毒疗效和治疗安全性。结果 个体化治疗组患者快速病毒学应答(RVR)、早期病毒学应答(EVR)、延迟病毒学应答(DVR)、治疗结束时病毒学应答(ETVR)、持续病毒学应答(SVR)获得率略高于标准化治疗组,复发率略低于标准化治疗组,但差异均无统计学意义(P>0.05);标准化治疗组中,HCV基因1型、非1型患者的SVR获得率比较差异无统计学意义(P>0.05),但 IL28基因分型CC型、非CC型患者的SVR获得率比较差异有统计学意义(P<0.05);个体化治疗组中,HCV基因1型、非1型患者的SVR获得率比较以及 IL28基因CC型、非CC型患者的SVR获得率比较差异均无统计学意义(P>0.05);个体化治疗组中HCV基因非1型、IL28基因非CC型患者的SVR获得率均明显高于标准化治疗组,差异均有统计学意义(P<0.05)。治疗过程中,标准化治疗组、个体化治疗组患者不良反应发生率分别为30.0%和20.0%,差异无统计学意义(P>0.05)。结论 IL28B基因分型能够影响慢性丙型肝炎患者的抗病毒治疗效果,而宿主 IL28B基因指导下的个体化方案治疗疗效较标准方案突出,患者耐受性好。
      【关键词】 IL28B基因型;慢性丙型肝炎;丙型肝炎病毒;个体化治疗;持续病毒学应答
      【中图分类号】 R512.6+3 【文献标识码】 A 【文章编号】 1003—6350(2018)10—1348—04
Comparison of efficacy of IL28B genotype-guided individualized regimen versus standardized antiviral therapyin the treatment of chronic hepatitis C. GU Bin. Department of Hepatology, the Second People's Hospital of Chenzhou,Chenzhou 423000, Hunan, CHINA
      【Abstract】 Objective To compare the clinical efficacy of IL28B genotype-guided individualized regimen andstandardized antiviral therapy in the treatment of chronic hepatitis C. Methods A total of 60 patients with chronic hepa-titis C, who admitted to the Second People's Hospital of Chenzhou from March 2012 to September 2014, were selectedand divided into the individualized treatment group and the standardized treatment group according to random number ta-ble method, with 30 cases in each group. The HCV RNA genotype and IL28B genotype were examined before the treat-ment. The standardized treatment group was treated with peginterferon (Peg-IFN) α-2a combined with ribavirin (RBV),lasting for 48 weeks, and the viral load during the treatment was measured. The treatment method for the individualizedtreatment group was adjusted on the basis of IL28B genotyping treatment, and the course of IL28B gene non-CC type pa-tients was prolonged to 72 weeks. The antiviral efficacy and treatment safety were compared between the two groups.Results The obtained rates of the rapid virological response (RVR), early virological response (EVR), delayed virologi-cal response (DVR), end of treatment virological response (ETVR), sustained virological response (SVR) in the individu-alized treatment group were slightly higher than those in the standardized treatment group, and the recurrence rate wasslightly lower than that in the standardized treatment group, without significant difference between the two groups (P>0.05). There was no significant difference in the obtained rates of SVR between the HCV genotype 1 patients andnon-HCV genotype 1 patients in the standardized treatment group (P>0.05), but there was significant difference in the ob-tained rates of SVR between the IL28 genotyping of CC and non-CC patients (P<0.05); In the individualized treatmentgroup, there was no significant difference in the obtained rates of SVR between HCV genotype 1 and non-HCV genotype1, and between IL28 genotype CC patient and non-CC patients (P>0.05). The obtained rates of non-HCV genotype 1 pa-tients and IL28 genotype 1 non-CC patients were significantly higher than those in the standardized treatment group (P<0.05). There was no significant difference in the incidence rate of adverse reactions between the standardized treatmentgroup and the individualized treatment group during the treatment (30.0% vs 20.0%, P>0.05). Conclusion Host IL28Bgenotype has an important impact on the treatment efficacy of Peg-IFN combined with RBV antiviral individualized ther-apy in patients with chronic hepatitis C. It can be used as an important predictor of SVR before the treatment.
      【Key words】 IL28B genotype; Chronic hepatitis C; Hepatitis C virus; Individualized therapy; Sustained virologi-cal response·论 著·doi:10.3969/j.issn.1003-6350.2018.10.005基金项目

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