FACTORS PREDICTIVE OF THE RESPONSE TO INTERFERON IN PATIENTS WITH CHRONIC HEPATITIS-C
FACTORS PREDICTIVE OF THE RESPONSE TO INTERFERON IN PATIENTS WITH CHRONIC HEPATITIS-C
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DOI：
10.1016/s0168-8278(94)80130-4
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发表时间：
1994-07-01
影响因子：
25.7
通讯作者：
POUPON, R
中科院分区：
文献类型：
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作者：
SERFATY, L;GIRAL, P;POUPON, R
预测慢性丙型肝炎患者干扰素应答的因素仍有待确定。在这项研究中，我们调查了75名接受重组α干扰素治疗的慢性丙型肝炎患者的短期应答(定义为治疗后丙氨酸氨基转移酶恢复正常)和长期应答(定义为治疗结束一年后丙氨酸氨基转移酶正常活性)的预测因素(每周6 MUx3，持续3个月，然后每周3 MUx3，持续3个月(n=27)或每周3 MUx3，持续6个月(n=48))。治疗结束时，42名患者(56%)丙氨酸氨基转移酶活性正常(“有效”)，33名(44%)丙氨酸转氨酶活性高(“无应答者”)。42名应答者中有20名(48%)在治疗1年后丙氨酸氨基转移酶活性正常(“持续应答者”)，而22名(52%)丙氨酸氨基转移酶活性高(“暂时性应答者”)。干扰素的剂量不能预测治疗的短期和长期反应。应答者和无应答者在年龄、静脉注射方面有显著差异。药物滥用、天门冬氨酸氨基转移酶、丙氨酸氨基转移酶和碱性磷酸酶活性、胆红素血症、血清胆汁酸浓度、凝血酶原时间、血小板计数、铁蛋白血症、透明质酸水平、重组免疫印迹抗体阳性5.1.1条带和组织学纤维化评分。在多变量分析中，以下参数与短期疗效独立相关：γ-谷氨酰转肽酶活性、血清胆汁酸浓度和重组免疫印迹检测区带5.1.1抗体阳性。γ-谷氨酰转肽酶活性(界值=40IU/L)和血清胆汁酸浓度(界值=12MU/L)的阳性预测值和阴性预测值分别为82/70%和75/90%。不能根据任何临床、生物学或组织学因素来区分持续应答者和瞬时应答者。这些发现表明，接触丙型肝炎病毒的危险因素和疾病阶段是干扰素短期应答的主要决定因素。胆汁淤积和胆汁酸似乎在干扰素抵抗中发挥了作用。这里研究的因素都不能预测长期反应。(C)《肝病杂志》。
Factors predictive of the response to interferon in patients with chronic hepatitis C remain to be identified. In this study, we investigated factors predictive of the short-term response, defined as a return to normal alanine aminotransferase activity after treatment, and the long-term response defined as normal alanine aminotransferase activity 1 year after completing treatment, in 75 patients with chronic hepatitis C virus treated with recombinant alpha interferon (either 6 MUx3/week for 3 months then 3 MUx3/week for 3 months (n=27) or 3 MUx3/week for 6 months (n=48)). At the end of treatment, 42 patients (56%) had normal alanine aminotransferase activity (''responders'') and 33 (44%) had high alanine aminotransferase activity (''non-responders''). Twenty (48%) of the 42 responders had normal alanine aminotransferase activity 1 year after treatment (''sustained responders''), while 22 (52%) had high alanine aminotransferase activity (''transient responders''). The dosage of interferon was not predictive of the short-term and the long-term response to treatment. The responders differed significantly from the non-responders in terms of age, i.v. drug abuse, aspartate aminotransferase, gammaglutamyltranspeptidase and alkaline phosphatase activities, bilirubinemia, serum bile acid concentrations, prothrombin time, platelet count, ferritinemia, hyaluronic acid levels, positivity for the antibody to 5.1.1 of the recombinant immunoblot assay band and the histological fibrosis score. The following parameters were independently correlated with the short-term response in a multivariate analysis: gammaglutamyltranspeptidase activity, serum bile acid concentrations and positivity for the antibody to 5.1.1 of the recombinant immunoblot assay band. The positive and negative predictive values of gammaglutamyltranspeptidase activity (cut off=40 IU/l) and serum bile acid concentrations (cut off=12 mu M/l) were respectively 82/70% and 75/90%. The sustained and transient responders could not be distinguished on the basis of any clinical, biological or histological factors. These findings suggest that the risk factor for exposure to hepatitis C virus and the disease stage are major determinants of the short-term response to interferon. Cholestasis and bile acids appear to play a role in resistance to interferon. None of the factors studied here was predictive of the long-term response. (C) Journal of Hepatology.