【摘要】 目的探讨本地区丙型肝炎的流行特征和基因型分布,探索提高丙型肝炎疗效的方法。方法调查了解丙型肝炎传播途径,对丙型肝炎病毒(HCV)进行测序分型,根据患者具体情况分别采用普通干扰素(IFN)联合利巴韦林(RBV)和聚乙二醇干扰素(PEG-IFN)联合RBV治疗,根据病毒基因型及应答情况等决定疗程,总疗程24～72周,对治疗过程中出现的不良反应进行适当处理。结果本地区HCV基因型有1a、1b、2a、3a、3b、6k型。1b型最多,占56.3%,其次为2a型占21.3%,1b和2a混合型占5.3%,3b型占9.6%,3a型占4.3%,1 a型占2.1%,6k型占1%。传播途径中通过静脉吸毒感染35.8%(102/285),输血及血制品感染31.2%(89/285)。基因1b型和非1b型两组早期病毒学应答(EVR)、治疗结束时病毒学应答(ETVR)、持续病毒学应答(SVR)分别为12(46.1%)、16(61.5%)、15(57.7%)和17(81.0%)、19(90.4%)、19(90.4%),差异均有统计学意义(P<0.05)。采取个体化治疗,能大幅提高丙型肝炎的应答率,减少不良反应,但因各个病例差异较大,无法进行统计学处理。结论皖北地区丙型肝炎的主要传播方式是静脉吸毒及输血;基因型以1b型为主,占56.3%,其次为2a型,并可见混合型及6k型。治疗上基因1b型疗效远不如非1b型。个体化治疗能明显提高SVR。更多还原

【Abstract】 Objective To determine the epidemiological characteristics,genotype distribution,and response to treatment of hepatitis C virus (HCV) infections in North Anhui.Methods The HCV transmission routes and genotypes were retrospectively assessed for 285 patients treated at our hospital between 2006 and 2012.Patients were treated with conventional interferon(IFN) plus ribavirin(RBV) or pegylated (PEG) - IFN plus RBV for 24 -72 weeks.Therapeutic efficacy was indicated by early virologic response(EVR),end of treatment virologic response(ETVR),sustained virologic response(SVR),and recurrence(relapse).Statistical significance of therapeutic efficacy and incidence of adverse effects was determined by Fisher’ s exact test.Results Six HCV genotypes were identified,including la,lb,2a,3a, 3b,and 6k.The proportion of patients with genotype 1 b was 56.3%(53/94),2a was 21.3%(20/94),1b+2a mix was 5.3%(5/94), 3b,was 9.6%(9/94),3a was 4.3%(4/94),1a was 2.1%(2/94),and 6k was 1%(1/94).The most common transmission routes were intravenous drug use(35.8%,102/285) and blood transfusion(31.2%,89/285).The rates of EVR,ETVR,and SVR were significantly lower in patients infected with genotype lb[12(46.1%),16(61.5%),and 15(57.7%),respectively]than in patients infected with non-lb genotypes[17(81.0%),19(90.4%),and 19(90.4%),respectively](all P < 0.05).Patients who received individualized treatment showed higher response rate and lower rate of adverse effects;however,the small number of patients receiving individualized treatment precluded statistical analysis.Conclusion The majority of HCV patients in North Anhui contracted the disease from intravenous drug use or blood transfusion.The dominant genotype is lb,followed by 2a and lb +2a mix;infections with genotype 3b,3a,la,or 6k were rare.Infections with genotype 1 b had better response to therapy than non -1b infections.Individualized therapy may significantly improve the SVR and should be considered for more widespread use.更多还原