發(fā)布時(shí)間：2018-01-24 18:24

  本文關(guān)鍵詞： 慢性丙型肝炎 影響因素 治療 快速病毒學(xué)應(yīng)答 早期病毒學(xué)應(yīng)答　出處：《大連醫(yī)科大學(xué)》2013年碩士論文　論文類型：學(xué)位論文

【摘要】：目的： 丙型肝炎是因感染丙型肝炎病毒（HCV）引起的傳染性肝病。從嚴(yán)重程度看，感染HCV有可能只出現(xiàn)幾周輕微的癥狀，也可能導(dǎo)致終身嚴(yán)重的肝病。全球每年有300~400萬人感染HCV，約有1.5億人患有慢性丙肝，并面臨進(jìn)展為肝硬化和/或肝癌的風(fēng)險(xiǎn)。每年約有35萬余人死于與丙肝相關(guān)的肝臟疾病。世界各地均存在丙型肝炎。中國是慢性HCV感染率高發(fā)的國家之一。已有的研究表明，慢性丙型肝炎患者接受聚乙二醇化干擾素（PEG-IFN）聯(lián)合利巴韋林（RBV）抗病毒治療后如果產(chǎn)生快速病毒學(xué)應(yīng)答（RVR）或早期病毒學(xué)應(yīng)答（EVR），將會(huì)有很大的幾率獲得持續(xù)病毒學(xué)應(yīng)答（SVR）。本研究的目的是分析接受抗病毒治療的慢性丙型肝炎患者血常規(guī)，肝功等血液生化因素對(duì)于獲得RVR和EVR的影響，為判斷其預(yù)后及實(shí)施個(gè)體化治療提供依據(jù)。 方法： 選取2009年1月至2012年6月在大連市第六人民醫(yī)院住院并接受PEG-IFN聯(lián)合RBV抗病毒治療的慢性丙型肝炎患者，共94例。PEG-IFN每周180μg，RBV根據(jù)體重每日給予800~1200mg。分別在治療前，治療第4周和第12周檢測HCV RNA，血常規(guī)和肝功。根據(jù)治療第4周時(shí)能否檢測到HCV RNA，將患者分為RVR組和無RVR組，根據(jù)治療第12周時(shí)能否檢測到HCV RNA，將患者分為完全早期病毒學(xué)應(yīng)答（cEVR）組和無cEVR組。對(duì)可能產(chǎn)生RVR和cEVR患者的血細(xì)胞和肝功以及其它因素進(jìn)行回顧性分析。 結(jié)果： 總共94名患者在研究當(dāng)中，平均年齡為46.93±13.38歲，，63.83%為男性。這些患者中54例（57.45%）獲得RVR，79例（84.04%）獲得cEVR。獲得RVR與未獲得RVR者相比，單因素分析中基線病毒載量（HCV RNA1×106IU/ml）與RVR有關(guān)（χ2=6.017，P=0.014），經(jīng)過多因素logistic回歸分析，基線病毒載量（OR:3.317;95%CI:1.291to8.521; P=0.013）和治療前紅細(xì)胞計(jì)數(shù)（OR:2.492;95%CI:1.099to5.650; P=0.029）是獲得RVR的獨(dú)立預(yù)測因素。獲得cEVR與未獲得cEVR者相比，單因素分析中丙氨酸氨基轉(zhuǎn)移酶與cEVR有關(guān)（P=0.007），經(jīng)過多因素logistic回歸分析，基線病毒載量（OR:5.040;95%CI:1.130to22.481;P=0.034）和治療前血小板計(jì)數(shù)（OR:1.018;95%CI:1.002to1.034; P=0.028）是獲得cEVR的獨(dú)立預(yù)測因素。重復(fù)測量資料分析顯示治療期間血細(xì)胞和肝功的變化對(duì)是否獲得病毒學(xué)應(yīng)答無影響。高血壓、糖尿病和脂肪肝與RVR或cEVR無關(guān)。天門冬氨酸氨基轉(zhuǎn)移酶與血小板比值指數(shù)是被推薦用于衡量肝纖維化的幾個(gè)指標(biāo)之一，它對(duì)是否獲得病毒學(xué)應(yīng)答無影響。 結(jié)論： 1.治療前基線病毒載量的高低是獲得RVR和cEVR的獨(dú)立影響因素。低病毒載量者易取得RVR或cEVR。 2.治療前血常規(guī)中的紅細(xì)胞計(jì)數(shù)是獲得RVR的獨(dú)立影響因素。紅細(xì)胞計(jì)數(shù)高者較低者更易獲得RVR。 3.治療前血常規(guī)中的血小板計(jì)數(shù)是獲得cEVR的獨(dú)立影響因素。血小板計(jì)數(shù)高者較低者更易獲得cEVR 4.治療過程中血常規(guī)，肝功指標(biāo)的變化，對(duì)是否獲得病毒學(xué)應(yīng)答無影響。
[Abstract]:Objective: Hepatitis C is an infectious liver disease caused by infection with hepatitis C virus (HCV). In terms of severity, HCV infection is likely to show mild symptoms for only a few weeks. It can also lead to life-long severe liver disease. Between 300 and 4 million people worldwide are infected with HCV each year, and about 150 million people suffer from chronic hepatitis C. And at risk of progression to cirrhosis and / or liver cancer. About 350,000 people die each year from liver disease associated with hepatitis C. Hepatitis C. China is one of the countries with high rates of chronic HCV infection. Existing studies have shown. Patients with chronic hepatitis C received PEG-IFN combined with ribavirin (RBV) as antiviral agents if they developed a rapid virological response (RVR) or an early virological response (RVR) or early virological response (RVR). EVR. The aim of this study was to analyze the blood routine of patients with chronic hepatitis C who received antiviral therapy. The effect of blood biochemical factors such as liver function on obtaining RVR and EVR provides basis for judging the prognosis and implementing individualized treatment. Methods: Patients with chronic hepatitis C who were hospitalized in Dalian 6th people's Hospital from January 2009 to June 2012 and received PEG-IFN combined with RBV antiviral therapy were selected. A total of 94 cases (180 渭 g / week) of PEG-IFN were given 800 ~ 1200mg per day according to body weight. HCV RNA was detected at week 4 and week 12 before treatment, respectively. According to whether HCV RNAs could be detected in the 4th week of treatment, the patients were divided into RVR group and no RVR group, and HCV RNA was detected according to the 12th week of treatment. The patients were divided into two groups: complete early virological response group and no cEVR group. The blood cells, liver function and other factors of patients with RVR and cEVR were analyzed retrospectively. Results: In a total of 94 patients in the study, the average age was 46.93 鹵13.38 years old and 63.83% were male. 54 of these patients (57.45) received RVR. RVR was obtained in 79 cases (84.04). The results were compared with those without RVR. In univariate analysis, the baseline viral load was correlated with RVR (蠂 2: 6.017) and RVR (P < 0.014). By multivariate logistic regression analysis, the baseline viral load was OR: 3.317; 95 CI: 1.291 to 8.521; (P < 0.013) and red blood cell count (OR: 2.492) before treatment; 95 CI: 1.099 to 5.650; Pu 0.029) was an independent predictor of RVR, and cEVR was compared with those without cEVR. In univariate analysis, alanine aminotransferase was associated with cEVR. By multivariate logistic regression analysis, the baseline virus load was OR 5.040; 95 CI: 1.130 to 22.481; (P < 0.034) and platelet count (OR: 1.018) before treatment; 95 CI: 1.002 to 1.034; Repeated measurement data analysis showed that changes in blood cells and liver function had no effect on obtaining virological response during treatment. Hypertension. Diabetes and fatty liver are not associated with RVR or cEVR. Aspartate aminotransferase / platelet ratio index is one of the recommended indicators for liver fibrosis. It has no effect on obtaining virological responses. Conclusion: 1. The level of baseline viral load before treatment was an independent factor for obtaining RVR and cEVR, and low viral load was easy to obtain RVR or cEVR. 2. Erythrocyte count in blood routine before treatment was an independent factor in obtaining RVR, and RVRs were more easily obtained in patients with high RBC count than those with lower RBC count. 3. Platelet count in blood routine before treatment is an independent factor in obtaining cEVR. High platelet count is more likely to obtain cEVR than low platelet count. 4. The changes of blood routine and liver function indexes had no effect on obtaining virological response.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R512.63

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