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目的探讨翻倍剂量长效干扰素联合利巴韦林治疗原发无应答慢性丙型病毒性肝炎(丙肝)的疗效。方法无应答慢性丙肝患者66例,入组后均行丙肝病毒(hepatitis C virus,HCV)基因型、白细胞介素(interleukin,IL)-28B基因rs12979860位点多态性检测;并给予翻倍剂量长效干扰素(360μg/次,1次/周,皮下注射)联合口服利巴韦林15mg/(kg·d),根据早期病毒学应答(early virological response,EVR)情况决定抗病毒疗程。比较不同HCV基因型、IL-28B基因位点患者持续病毒学应答(sustained virus response,SVR)率、复发率、无应答率。结果 66例中HCV基因1b型57例,HCV基因2a型9例;IL-28Brs12979860位点是CC型19例,CT型23例,TT型24例;基因1b型患者中实现SVR率为31.6%,无应答率为56.1%,复发率为12.3%,基因2a型患者中实现SVR率为22.2%,无应答率为55.6%,复发率为22.2%,不同基因型患者SVR率、复发率、无应答率比较差异均无统计学意义(P>0.05);IL-28B rs12979860位点为CC型患者SVR率为63.16%、复发率为15.79%、无应答率为21.05%,IL-28Brs12979860CT型患者SVR为34.78%、复发率为8.70%,无应答率为56.52%,IL-28Brs12979860TT型患者SVR率为0,复发率为14.67%,无应答率为83.33%,IL-28Brs12979860CC组与TT组,IL-28Brs12979860CT组与TT组SVR率、无应答率比较差异有统计学意义(P<0.05)。结论 IL-28B基因rs12979860位点多态性可预测翻倍剂量长效干扰素联合利巴韦林再治疗无应答慢性丙肝的疗效。
Objective To investigate the efficacy of doubled-dose long-acting interferon combined with ribavirin in the treatment of primary unresponsive chronic hepatitis C virus (HCV). Methods Sixty-six patients without response to chronic hepatitis C (HCV) were enrolled in this study. HCV genotype and rs12979860 polymorphism of interleukin (IL) -28B gene were detected in all the patients. Double dose Long-acting interferon (360μg / time, once a week, subcutaneous injection) combined with oral ribavirin 15mg / (kg · d), according to early virological response (early virological response, EVR) decided to antiviral therapy. To compare the sustained virus response (SVR) rate, relapse rate, and non-response rate in patients with different HCV genotypes and IL-28B loci. Results Among the 66 patients, 57 were HCV genotype 1b and 9 HCV genotype 2a. IL-28B rs12979860 locus was found in 19 CC patients, 23 CT patients and 24 TT patients. The SVR rate was 31.6% , The non-response rate was 56.1% and the recurrence rate was 12.3%. The SVR rate was 22.2% in genotype 2a patients, the non-responsive rate was 55.6% and the recurrence rate was 22.2%. The SVR rate, relapse rate, (P> 0.05). The SVR rate was 63.16% in CC-type patients with IL-28B rs12979860 locus, the recurrence rate was 15.79%, and the non-responsive rate was 21.05%. The SVR of IL-28B rs12979860CT patients The recurrence rate was 8.70% and the non-response rate was 56.52%. The SVR rate was 0, the recurrence rate was 14.67% and the non-response rate was 83.33% in IL-28B rs12979860TT patients. 28Brs12979860CT group and TT group SVR rate, no response rate difference was statistically significant (P <0.05). Conclusion Polymorphism of rs12979860 locus in IL-28B gene can predict the efficacy of doubled-dose long-acting interferon plus ribavirin re-treatment of chronic hepatitis C without response.