| ObjectiveTo evaluate the effect of the anti-viral treatment with pegylated interferon a-2a and ordinary interferon a-2b respectively in combination with ribavirin in hepatitis C and possible influence factors. In addition, try to provide some reference for chronic hepatitis C patients so that they can choose a more appropriate anti-viral treatment based on the evaluation of the effect of the two different types of treatment through the dividing the HCV RNA load into higher and lower groups in initial anti-viral treatment.ApproachBased on clinical data on297chronic hepatitis C patients who have undergone treatment at the Infection Department of No.1Affiliated Hospital of Zhengzhou University during two years from January2009to January2011, a retrospective cohort study is done to identify the effects, factors influencing the effects as well as the predictive factors. Among the297cases,155cases are treated with pegylated interferon a-2a in combination with ribavirin while the other142cases ordinary interferon a-2b in combination with ribavirin. Comparison of demographic characteristics like gender and age, initial HCV virus load before treatment, HCV genetic typing and other clinical features are made between the two groups to figure out the comparability between the two groups treated with different types of interferon, while deference in acquired RVR, EVR and SVR after the anti-viral treatment between the two groups is observed to evaluate the effects of the two different kinds of treatment. Through grouping the cases by the baseline virus load into the lower virus load group (HCV RNA<105IU/ml) and the higher virus load group (HCV RNA≥105IU/ml), analysis of the difference in acquired RVR, EVR and SVR after the anti-viral treatment with pegylated interferon a-2a and ordinary interferon a-2b respectively in combination with ribavirin between the two groups is done to evaluate the effects between the two different ways of treatment.Result1. Little difference is observed between the two groups (i.e. pegylated interferon a-2a plus ribavirin v.s. ordinary interferon a-2b plus ribavirin) in terms of demographic characteristics and initial clinical features.2. Analysis of possible predictive factors that affect the treatment of interferon are as follows:With SVR rates of the male group and female group being respectively61.5%and52.9%, it can be found that P<0.01after comparison, namely the male has higher SVR than the female. With SVR rates of the group with age over or equal to40(≥40group) and the group with age under40(<40group) are respectively51.4%and67.2%, it can be found after comparison that P<0.003, making statistical difference as P<0.05; that is to say, the<40group has higher SVR than the≥40group.With SVR rates of the group of which the body mass index (BMI) is under25kg/m2and the group of which the BMI is over or equal to25kg/m2being58.0%, and56.1%, it can be found after comparison that the P value is0.618, making no statistical difference as P>0.05. With SVR rates of the group with higher HCV RNA (HCV RNA≥105IU/ml) and the group of lower HCV RNA (HCV RNA<105IU/ml) being respectively52.1%and64.6%, it can be found after comparison that the P value is0.004, making statistical difference as P<0.05and revealing that the group of lower HCV RNA has higher SVR than the other groupWith SVR rates of the Gene-Type-1group and the Non-Gene-Type-1group being48.3%and77.7%respectively, it can be found after comparison that the P value is lower than0.001, making statistical difference and revealing that Non-Gene-Type-1group has higher SVR than the other group. With SVR rates of the group in which pegylated interferon a-2a is used with ribavirin and the group in which ordinary interferon a-2b is used with ribavirin being65.1%and49.3%respectively, it can be found that the P value is0.01, making statistical difference as P<0.05and revealing that the former group has higher SVR than the latter.With SVR rates of the group that has acquired RVR and the group that has not being74.2%and12.5%respectively, it can be found that the P value is0.007, making statistical difference as P<0.05and revealing the former group has higher SVR.With SVR rates of the group that has acquired EVR and the group that has not being71.4%and6.3%respectively, it can be found that the P value is0.009, making statistical difference as P<0.05and revealing the former group has higher SVR.It is identified that gender, age, HCV RNA, gene type, type of interferon and the presence of RVR and EVR are all predictive factors of SVR as revealed both by uni-variate analysis and multi-variate analysis.3. Analysis of the effects of the treatment with the two interferon With EVR rates of the group in which pegylated interferon a-2a is used with ribavirin and the group in which ordinary interferon a-2b is used with ribavirin being84.5%and72.5%respectively, it is found that P=0.02after comparison, making statistical difference. With SVR rates of the group in which pegylated interferon a-2a is used with ribavirin and the group in which ordinary interferon a-2b is used with ribavirin being65.1%and49.3%respectively, it can be found that P=0.01, making statistical difference as P<0.05and revealing that the former group has higher SVR than the latter. Also with the RVR rates of the two groups being77.4%and68.3%respectively, the P values are0.10and0.60in terms of RVR, making no statistical difference as P>0.05.4. Identify the RVR, EVR and SVR and analyze the difference through the grouping by the baseline HCV RNA load before the anti-viral treatment. Group further by virus load and have two cases labeled as higher virus load case (HCV RNA≥105IU/ml) and lower virus load case (HCV RNA<105IU/ml). When HCVRNA is in higher case (i.e.≥105IU/ml), the rate of RVR of pegylated interferon a-2a in combination with ribavirin is74.7%, EVR81.6%and SVR63%, while the rate of RVR, EVR and SVR of ordinary interferon a-2b being58.7%,62.5%, and40%respectively; hence making statistical difference, and revealing that the RVR, EVR and SVR rates of pegylated interferon a-2a in combination with ribavirin are higher with HCVRNA being higher. When HCVRNA is in lower case (i.e.<105IU/ml), the RVR, EVR and SVR of pegylated interferon a-2a amounts to80.9%,88.2%, and67%respectively, while those of ordinary interferon a-2b severally registers80.6%,85.5%and61.3%, making no statistical difference (P>0.05).Conclusion1. It is identified that gender, age, HCV RNA, gene type, type of interferon and the presence of RVR and EVR are all predictive factors of SVR. That’s why it is suggested to use pegylated interferon a-2a together with ribavirin for the treatment of over-40-year-old females with higher baseline virus load (HCV RNA≥105IU/ml) and Type1Gene, as well as without RVR and EVR. Extended course of treatment is also optionally for higher SVR rate and reduced possibility of relapse.2. Treatment with pegylated interferon a-2a together with ribavirin has higher EVR and SVR rates than that with ordinary interferona-2b together with ribavirin. 3. The RVR, EVR and SVR rates of pegylated interferon a-2a in combination with ribavirin are higher than that of ordinary interferona-2b in combination with ribavirin with the virus load being higher (HCV RNA≥105IU/ml), while RVR, EVR and SVR rates are about the same between the two groups with the virus load being lower (HCV RNA<105IU/ml).This explains why pegylated interferon a-2a together with ribavirin is recommended to be used in the treatment in case the virus load is higher (HCV RNA≥105IU/ml), while the patient can opt for the treatment with ordinary interferona-2b in combination with ribavirin if he is economically constrained. |
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