Factors Associated With The Clinical Outcomes And Effectiveness To Interferon Treatment In Chronic Hepatitis C Patient

ObjectiveFirst, to analysis the clinical features (Gender, alanine aminotransferase level, viral load, infection means, the infection ages, therapy, risk factors of metabolic syndrome) of the patients infected chronically with hepatitis C virus, and find the correlation factors associated with disease progression. Second, to determine the various factors associated with sustained virological response(SVR) in chronic hepatitis C patients treated with interferon alpha and ribavirin combination therapy,predict the disease outcome and give individualized therapy.MethodsThe clinical data of 259 patients infected chronically with hepatitis C virus hospitalized or outpatient at the Department of Infectious Disease of Shanxi Medical University were collected from 2001～2010. The patients were divided into chronic hepatitis C patients group (CHC) and liver cirrhosis group(LC) according to the clinical characteristic and the results of imaging diagnosis, A retrospective analysis were performed to explore the possible influence factors associated with disease progression from CHC to LC. Out of 259 HCV infected patients,124 patients completed whole interferon alpha combining ribavirin therapy,we further retrospectively examined the basline and on-treatment factors associated with the rapid virological response (RVR), complete early virological response (CEVR) and sustained virological response (SVR).ResultsOut of 259 patients, there were 177 cases of CHC (68.3%) and 82 (31.6%) cases of LC (among which, 11 patients accompanying hepatocellular carcinoma) . Compared to the CHC patients group, the infection ages in LC patients group were older (p<0.001), the AST level were higher ((P<0.05), but ALT level, Gender, HCVRNA load, body mass index(BMI) and the duration on HCV infection were no significant difference in two group patients. The LC incidence were no significant difference ( P>0.05) in two groups of patients infected HCV by blood transfusion and by the other infection routes(33.6% vs 22.9%). The duration from infection HCV to progress to LC was shorter in the group infected by blood transfusion than by other routes of infection (P<0.05). There were 19.5% and 51.0% patients developed to LC in patients who accepted antiviral therapy and not accepted antiviral therapy respectively (P<0.001). The patients who accompany metabolic syndrome risk factors developed LC proportion was higher than the patients no metabolic syndrome risk factors (P<0.05). Multivariate regression analysis showed that the ages of infection HCV > 40 years old(OR:2.488;P=0.006),no antiviral therapy(OR:3.605;P<0.001), accompany risk factors of metabolic syndrome(OR:1.829;P=0.04)were independent risk factors for CHC patients developed LC.Out of 259 patients, 124 patients completed antiviral therapy in this research. Among them,54(43.5%) patients acquired rapid viralogical response(RVR),92(74.2%) patients acquired completed viralogical response(cEVR),77( 62.1%) patients achieved sustained viralogical response(SVR), 24(19.4%) patients suffered relapse, 23(18.5%) patients were no responser (NR).Out of 54 patients who acquired RVR,44(81.5%) patients achieved SVR. Out of 92 patients who acquired cEVR,74(80.4%) patients achieved SVR. In a multivariate logistic regression analysis showed that age≤40 years old (OR:1.800;P=0.05),HCVRNA≤400000copy/ml(OR:6.168;P<0.001), absence of cirrhosis (OR:10.754;P=0.003),combining with ribavirin in antiviral therapy (OR:9.446;P=0.002),female(OR:10.754;P=0.003)and no drinking (OR:4.589; p=0.034) were all the independent relative factors of RVR. In additional, no metabolic syndrome risk factors (OR:3.261;P=0.05) and using PEG-IFN in antiviral therapy (OR:14.029;P=0.042) were independent relative factors of cEVR. The factors related to SVR included age≤40 years old (OR:3.553;P=0.029), absence of cirrhosis (OR:6.427; P=0.008), combining with ribavirin in the treatment (OR:17.199;P<0.001), using PEG-IFN in antiviral therapy(OR:6.014;P=0.042), acquired RVR (OR:4.474;P=0.004) and cEVR(OR: 13.284;P<0.001). the SVR were higher in the patient using ribavirin dose≥13mg/kg/day than those using ribavirin≤13mg/kg/day (75.7% vs 44.4%,P<0.001).The patients who accompany metabolic syndrome risk factors acquired lower SVR than those no metabolic syndrome risk factors(44.7% vs 72.7%, P=0.002 ). Conclusion1.The factors correlated with CHC progressed to LC include:high AST level, infecting HCV by blood transfusion, no antiviral therapy, infection age>40 years old, accompany metabolic syndrome risk factors, especially, the last three factors were independent risk factors for CHC developed to LC. 2. The profitable factors for SVR are lower HCVRNA≤400000copy/ml, younger (age<40 years old),non-cirrhosis,no metabolic syndrome risk factors, combining with ribavirin and ribavirin dose≥13mg/kg/day in antiviral treatment, female, no drinking, acquired RVR during antiviral therapy.