| Objective:To study the clinical efficacy and side effects of PEG-IFNα-2acombined with ribavirin in eldly chronic hepatitis C.Methods:66patients with chronic hepatitis C were selected,they were all treatedin the Infectious Diseases outpatient and inpatient department of Peking University FirstHospital from2009to2011.There are20patients in the elder(≥60years old) group and46patients in the younger(<60years old) group.Both groups received PEG-IFNα-2a180μg/w combined with ribavirin800~1000mg/d treatment for48weeks whichfollowed by an untreated24week follow-up period.The baseline clinical characteristics,rapid virological response(RVR) rate,early virological response(EVR) rate,end oftreatment virological response(ETVR) rate,sustained virological response (SVR)rate,non-response(NR) rate,relapse rate and the side effects were assessed,then tocompare the differences between the two groups.The serum biochemical indicators weredetected by the Beckman automatic biochemical analyzer.Quantitative PCR method wasused to detect serum HCV RNA load. Restriction fragment length polymorphismsmethod was used to detect HCV RNA genotypes.Results:1.The differences of gender,genotype,weight,BMI,ALT and the mean levels ofHCV RNA were not statistically significant before treatment (P>0.05).However,theprevalence of complications(diabetes, hypertension) in the elder group was significantlyhigher than that in the younger group(P<0.05).2.The RVR rate,EVR rate,ETVR rate,SVR rate,NR rate,relapse rate in the eldergroup was60.00%,80.00%,82.35%,55.56%,17.65%,33.33%respectively,the rate inyounger group was52.17%,78.26%,87.5%,82.35%,12.5%,17.65%respectively. Thedifferences between the two groups were not statistically significant(P>0.05).3.At4,12,48week and follow-up24week,the ALT normalization rate of the elder group and younger group was58.33%,66.67%,77.78%,83.33%and53.13%,68.75%,90%,91.67%respectively.The differences were not statisticallysignificant(P>0.05).The ALT normalization rates of the two groups showed a risingtrend with the extension of the treatment period.4.In this study, the main side effects caused by PEG-IFNα-2a and ribavirin wasleukopenia, neutropenia, thrombocytopenia, hemoglobin decreased,flu-like symptoms,loss of appetite, alopecia and skin rash.The elder group had a higher leukopenia rate than the younger group(90%vs67.39%), but the difference between the two groups was not statistically significant(P>0.05). The elder group had the significantly higher neutropenia rate(80%vs54.35%,P<0.05) and thrombocytopenia rate (80%vs39.13%,P<0.05).The hemoglobindecreased rate of two groups was30%and23.91%,the difference was not statisticallysignificant(P>0.05).Fever is most common among flu-like symptoms,the difference of flu-likesymptoms between the two groups was not statistically significant(P>0.05). Alopeciaand gastrointestinal reactions in which loss of appetite is the main symptom had nostatistically difference between the two groups(P>0.05).5.No patient exited treatment due to the serious side effects.11patients reducedPEG-IFNα-2a dose,including3elderly(15%) and8younger (17.39%) patients.13patients reduced ribavirin dose,including5elderly (15%) and8younger(17.39%)patients.19patients stopped PEG-IFNα-2a temporarily,including7elderly(35%) and12younger(26.09%) patients.8patients stopped treatment because of noresponse,including3elderly(15%) and5younger(10.87%) patients.The differenceswere not statistically significant(P>0.05).Conclusions: Elderly patients with chronic hepatitis C have the higher prevalenceof complications(diabetes,hypertension) compared with younger patients. If thecomplications can be controled actively,and the side effects can be processedtimely,using PEG-IFNα-2a plus ribavirin,elderly patients can achieve more satisfactoryvirological response rate.They also can tolerate the therapy well and complete thetreatment.Treatment of CHC with PEG-IFNα-2a plus ribavirin therapy was comparablyeffective and safe among elderly patients. |
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