【摘要】 目的探讨老年慢性丙型肝炎患者抗病毒疗效及影响因素。方法回顾性分析42例老年慢性丙型肝炎患者经聚乙二醇干扰素(Peg-IFNα-2a)联合利巴韦林治疗48周随访24周的病毒学应答、复发及无应答情况,分析与病毒学应答相关的影响因素。结果 42例老年慢性丙型肝炎患者获得快速病毒学应答(RVR)、早期病毒学应答(EVR)、持续病毒学应答(SVR)比例分别为42.9%、78.6%、57.1%,复发率为26.2%,无应答率为21.4%。RVR组、EVR组的SVR为77.8%、72.7%,均高于非RVR组、非EVR组的41.7%、0(P值分别为0.02、0.00)。SVR组的病程(10.0±4.6)年、基线HCV RNA(5.67±0.82)lg拷贝/mL、基因Ⅰ型占45.8%,显著低于非SVR组的(17.2±5.6)年、(6.39±0.92)lg拷贝/mL和83.3%(P值分别为0.00、0.02、0.01);IL-28B基因多态性CC等位基因为83.3%,明显高于非SVR组的50%(P=0.02)。81%的老年慢性丙型肝炎患者感染途径是有手术史或输血史,78.6%的患者病程>10年。结论老年慢性丙型肝炎患者可获得较高的病毒学应答率。感染HCV年限、基线HCV RNA载量、非基因Ⅰ型以及IL-28B等位基因CC型和RVR、EVR是预测抗病毒疗效的影响因素。更多还原

【Abstract】 Objective To explore antiviral efficacy and the influencing factors in elderly patients with chronic hepatitis C.Methods Clinical data for 42 elderly patients with chronic hepatitis C were analyzed retrospectively.Influencing factors of virological response were evaluated.Results Forty-two elderly patients with chronic hepatitis C,who received peginterferon(Peg-interferonsα-2 a)plus ribavirin treatment for 48 weeks,were followed-up for 24 weeks.Proportions of rapid virological response(RVR),early virological response(EVR),sustained virological response(SVR)were 42.9%,42.9% and 57.1%,respectively.Relapse rate was 26.2%,and non-response rate was 21.4%.SVR in RVR or EVR group(77.8%,72.7%)was higher than that in non-RVR or non-EVR group(41.7%,0%)(P=0.02,0.00).Compared with non-SVR group,SVR group had significantly shorter disease course(10.0±4.62 years vs.17.2±5.63 years,P=0.00),lower HCV RNA level at baseline(5.67±0.82 log10copies/ml vs.6.39±0.92 log10 copies/ml,P=0.00)and less genotype I patients(45.8% vs.83.3%,P=0.01).IL-28 B gene polymorphism CC(83.3%)was significantly higher in SVR group than that in non-SVR group(50%)(P=0.02).Eighty-one percent of the elderly patients with chronic hepatitis C had histories of surgery or blood transfusion,and 78.6% of those patients′disease courses were more than ten years.Conclusion Elderly patients with chronic hepatitis C can obtain higher virological response rates.Disease course of hepatitis C, HCV RNA loads at baseline,genotype,IL-28 B gene polymorphism CC,RVR and EVR are influencing factors which could predict the efficacy of antiviral therapy.Elderly patients with chronic hepatitis C should be paid more attention to early screening,early diagnosis and early treatment.更多还原