| There are30-40million new Hepatitis C virus infected patients worldwide each year,this kind of phenomenon also appears in China. After HCV infection, about75-80%ofpatients cannot spontaneously clear HCV and develop into chronic infection. The currentstandard of interferon plus ribavirin treatment can only make about half of the patients cured,the rest may progress to liver cirrhosis or liver cancer. This has become the main causes ofliver transplantation in the western country. Adherence against HCV curative effect plays animportant role in HCV clearance. Although the importance of treatment adherence in chronicdiseases has been reported, actually, it is hard to avoid because of various reasons. Therefore,the relationship between non-adherence and effect is important for further analysis. Hostimmune response to hepatitis C virus (HCV) is a vital factor involved in both viral clearanceand liver disease pathogenesis. CD24plays an important role in inflammation and immuneresponse and CD24polymorphisms are associated with the risk and progression of chronichepatitis B virus infection., while there is no related reports about the effect of CD24onHCV spontaneous clearance or the one induced by HCV antiviral therapy. This studyfocused on compliance changing of chronic HCV infection patients and its influence on thecurative effect in the real life. At the same time, we analyzed whether another important hostimmune molecules CD24could affect the efficacy of antiviral therapy for chronic HCVpatients.First, we use common interferon alpha2b, subcutaneous injections5MU three times aweek combained with ribavirin oral900mg/day for48weeks. Follow-up for24weeks, Wedo cross-sectional study in353patients treated before, including baseline liver patients’general information, virological, biochemical, and radiographic evaluation, and for thetreatment of patients with HCV and education on anti-virus therapy. Cohort study included0weeks after starting treatment,2weeks,4weeks,12weeks,24weeks,48weeks and72weeks to review and feedback, counting drugs, monitoring of HCV RNA loads, liverbiochemistry, imaging changes and medication adherence, adverse reactions and thetreatment correspondce.Results are as follows in the first part:Intentionality (ITT) and per protocol (PP) analysis indicates that antiviral treatment response at24weeks after treatment began to reach the highest, followed by mild decline;At the beginning of the first12weeks after treatment, two kinds of antiviral drugcompliances were high, as the treatment progressing, medication adherence of the two drugswere declining, especially for ribavirin.Early virological response (EVR) and sustained virological response (SVR) of ribavirinincrease according to the increasing of the medication adherence. Ribavirin response rates ofribavirin adherence≥60%patients was obviously higher than those of ribavirin adherence <60%patients.Effects on Ribavirin adherence is more obvious in patients with HCV genotype1Bpatients than type2A;The rate of SVR is significantly higher in treatment adherence≥60%than treatmentadherence <60%patients during each12weeks interval.We also analysis the cause of poor compliance, expect for prompting the medical staff,strengthen the supervision on patients, obtaining good curative effect. Results showed thatthe adverse drug reactions (Fatigue, pain in the whole body, platelets and white blood cellsreduction, dizziness, hypothyroidisim, rashes, anemia, depression) and other non-medicalreasons (travelling, busy farming, trauma) were the major cause of poor compliance.In the second part, we genotyped544chronic hepatitis C (CHC) patients,78spontaneous hepatitis C clearance (SHC) patients and215healthy controls for CD24genevariants at positionsP534, P170, P1527and IFNL3rs12979860by pyrosequencing. InCHC patients,362individuals were treated with a recombinant IFN-a2b/ribavirin for48weeks then followed up for an additional24weeks. CD24expression on lymphocyte wasanalyzed by flow cytometry.Results are as follows in the second part:P170CT and CT/TT genotypes were over-represented in the SHC group compared toCHC patients (62.8%vs.47.2%and75.6%vs.60.3%, for respective polymorphisms).In multivariate logistic analysis, P170(CD24Ala57Val) polymorphism was anindependent predictor of SHC (adjusted OR=2.11,95%CI=1.19–3.73, P=0.010for CTgenotype; OR=2.01,95%CI=1.15–3.49, P=0.014for CT/TT genotype).No significant association was found between the CD24polymorphisms andtreatment-induced viral clearance by log-rank analysis and Cox regression analysis. Patientswith the CT/TT genotype had higher T-cell CD24expression than patients with the CCgenotype. In conclusion, treatment adherence reduce gradually with antiviral treatment going on,ribavirin is more apparent so ribavirin higher compliance can lead to higher EVR and SVR.What’s more, this phenomenon was more important in HCV genotype1B patients.CD24Ala57Val polymorphism and associated variations in CD24expression may be animportant predictor for SHC, but it has no effect on antiviral drug treatment response inChinese CHC patients... |
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