| Objective:Hepatitis C virus(HCV)infected an estimated 185 million individuals worldwide and 10 million people in China.The number of new patients were 200000 every year,and continued to increased every year.In China,it became an important public health problem.HCV infection was likely the main cause of liver cirrhosis and hepatocellular carcinoma.The effective antiviral therapy could prevent the development of disease,and improve the quality of life.In recent years,the application of direct-acting antiviral drugs(DAAs)was exciting.However,DAAs has yet officially approved in China.At the same time,it has the disadvantages of the resistanc(SVR)were 80-90%.It was reported that patienrs infected with HCV genotype 3 had s e-associated variants and high cost.Morever,DAAs had not expected efficacy of patients with HCV genotype 3.However,the study indicated that the majority of patienrs in China carrying with the rs12979860 CC genotype and the antiviral treatment response of pegylated interferon α(PEG-IFN-α)plus ribavirin(RBV)(PR)was significantly higher than European and American countries.So,the PR was still the mainly antiviral therapeutic regimen for the patients with CHC nowadays in China.The efficacy of PR therapeutic regimen was closely associated with HCV genotypes.In China,the majority of CHC patients were infected with genotype 1b.Patients infected with HCV genotype 2/3 accounted for about 33.2% in the total.Patients with HCV genotype 2/3 were considered as relatively sensitive to PR therapeutic regimen.The ratio of sustained virological response hown some remarkable characteristics different from that of other genotypes,such as high rate of hepatic steatosis and rapid progress to liver fibrosis.The efficacy of patients infected with HCV genotype 3 who received PR therapeutic regimen had less than that of HCV genotype 2.Especially,in the patients with high viral load,the SVR ratio was just about 58%.The efficacy of patients with HCV 3 was almost closed to that of HCV genotype 1.The viewpoint that HCV genotype 3 was considered as potentially difficult to handle about interferon.At present,there were not enough data regarding the efficacy between patients with HCV genotypes 2/3 in China.The study retrospectively observed the differences between patients infected with HCV genotypes 2 and 3 who received PR therapeutic regimen.The aim of our study was to provide the basis of individualized treatment of patients infected with CHC.Methods:The clinical data of patients infected with HCV genotypes 2/3 who received PR therapeutic regimen in south hospital were comprehensively collected as possible as we can.The number of patients which we were collected was 728 cases.Patients should meet the following inclusion criteria:(1)In line with the HCV diagnostic criteria and treatment indications of the prevention and treatment of Hepatitis C Guide published in 20 04;(2)Age ranged from 16 to 70 years;(3)Received treatment therapy of PEG-IFN-α and RBV,include PEG-IFN-α-2a 180/135μg or PEG-IFN-α-2b 1.5μg/kg,once a week,and combined with RBV 800-1200 mg/d.Exclusion criteria:(1)Co-infection with HBV/HIV;(2)Coinfection with autoimmune liver disease,uncontrolled diabetes and hypertension;(3)symptoms of heart disease;(4)seriously mental disease;(5)decompensated hepatic cirrhosis;(6)the acute organ transplantation;(7)interferon treatment experienced.Patients who conformed to the above inclusion and exclusion criteria were 214 cases in total.Excluded the 61 cases of patients with reducing dosage and duration,and not being followed up to 24 weeks,150 cases of patients contained into analyzed.We were retrospectively collected the information,include age,sex,genotype,the base-line HCV RNA,therapeutic process,drugs,abdominal ultrasound,Fibro Scan,blood routine,glutamic-pyruvic transaminase(ALT),glutamic-oxalacetic transaminase(AST)and so on.Recorded the HCV RNA of antiviral treatment 4,12 weeks,end of the course and course over 24 weeks,and compared the ratio of rapid virological response(RVR)、early virological response(EVR)、sustained virological response(SVR)of patients infected with HCV genotypes 2/3;Observed antiviral treatment of relapse,adverse drug reactions of patients infected with HCV genotype 2/3.The data were analyzed by using SPSS 22.0 statistical software.Count data were used squared inspection,measurement data were used t test or rank sum test.Influencing factors were used binary regression analysis.The statistical inspection level was defined as the value of P less than 0.05.Results:1.Analysis of antiviral efficacy1.1 150 cases of patients with HCV genotypes 2/3 who received PR therapeutic regimen were analyzed.Patients had a good efficiacy of PEG-IFN-α and RBV.In this group,the RVR ratio was 83.46%(106/127),the EVR ratio was 95.35%(123/129),the SVR ratio was 94.67%(142/150).1.2 In analysis of subgroups,the SVR ratio of patients with HCV genotypes 2a,3a,3b respectively were 100%,100%,89.47%.The SVR ratio of patients with HCV genotype 3b was less than HCV 3a(P=0.03).The SVR ratio of patients with HCV genotype 3b was significantly less than patients with HCV genotype s 2a and 3a(P<0.01).1.3 8 cases of patients who received PR therapeutic regimen had virus failure.They were all HCVgenotype 3b.2.RVR,EVR were as predictors of SVRThe SVR ratio of patients who received PR therapeutic regimen achieved EVR was 98.37%(121/123),the SVR ratio of patients who received PR therapeutic regimen not achieved EVR(non-EVR)was 33.33%(2/6).There were difference between two groups(χ2=40.89,P<0.001),The patients who achieved EVR have a better SVR ratio than non-EVR.Influencing factors of EVR,the value of odds ratio was 106.27,95% confidence interval was 6.06-1863.08,p=0.001.It was demonstrated that EVR could effectively predict the SVR.But RVR had not a significantly predictive role in SVR.3.Analysis of drug safety214 cases of patients with HCV genotypes 2/3 in drug adverse events were analyzed.The number of patients who had at least one adverse event(AE)were 185(86.45%)cases.The incidence of stopping or reducing drug dose were 14.49% or 2.80%.The common adverse events were platelet decreased 112(52.34%)cases,granulocytopenia 78(36.45%)cases,anemia 41(19.16%)cases,thyroid dysfunction 20(9.35%)cases and so on.Conclusion:1.PEG-IFN-α plus RBV therapeutic regimen had a good efficacy of patients with HCV genotypes 2/3.It was demonstrated that genotype 3b may be difficult to handle relatived to genotype 2a and 3b.2.EVR could effectively predict the SVR among patients infected with HCV genotypes 2/3.But RVR had not a significantly predictive role in SVR.3.The incidence of drug adverse events was high among patients infected with HCV genotypes 2/3 who received PR therapeutic regimen.The common adverse events were platelet decreased,granulocytopenia,anemia,thyroid dysfunction.The drug adverse events should be closely monitored in the antiviral treatment with PR therapeutic regimen. |
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