目的 观察聚乙二醇干扰素(Peg-IFN) α-2a或Peg-IFN-α-2b联合利巴韦林(RBV)治疗慢性丙型肝炎(CHC)患者的疗效和安全性.方法 237例CHC患者根据应用Peg-IFN的种类不同分为两组:A组165例,采用皮下注射Peg-IFN-α-2a治疗;B组72例,采用皮下注射Peg-IFN-α-2b治疗.两组均同时每日服用RBV 1000 mg(体重＜75 kg)或1200 mg(体重≥75 kg).基因1型疗程为48周,基因2、3型疗程为24周.分别于治疗前、治疗后4和12周、治疗结束时和治疗结束后24周检测血清HCV-RNA载量,同时记录治疗期间患者不良反应的发生情况.结果 治疗后,A组快速病毒学应答(RVR)率高于B组(93.3％ vs.80.6％)(P＜0.05),两组的完全早期病毒学应答(cEVR)率、治疗结束时病毒学应答(ETVR)率以及持续病毒学应答(SVR)率比较差异无统计学意义(P＞0.05).A组中性粒细胞减少及ALT升高率高于B组(P＜0.05),而甲状腺功能异常率低于B组(P＜0.05).两组的流感样症状、贫血、血小板减少、脱发、精神异常发生率比较差异无统计学意义(P＞0.05).结论 与联合应用Peg-IFN-α-2b和RBV比较,联合应用Peg-IFN-α-2a和RBV治疗CHC能获得较高的RVR率.%Objective To compare the efficacy and safety of peginterferon (Peg-IFN) a-2a or α-2b combined with ribavirin(RBV) in the treatment of patients with chronic hepatitis C(CHC).Methods A total of 237 CHC patients was treated with subcutaneously injection of Peg-IFN-α-2a (group A,165 cases) or subcutaneously injection of Peg-IFN-α-2b(group B,72 cases) combined with RBV.RBV was taken orally in a dose of 1000 mg(body weight ＜75 kg) or 1200 mg (body weight ≥75 kg) per day.The treatment lasted for 48 weeks in the cases with CHC genotype 1 or 24 weeks in the cases with CHC genotype 2 or 3.Serum levels of HCV-RNA were measured before treatment,4,12 weeks after treatment,at the end of treatment,and 24 weeks after the end of treatment.The incidence of adverse effects during the treatment was recorded.Results The percentage of rapid virological response (RVR) in group A was significantly higher than that in group B(93.3％ vs.80.6 ％) (P＜0.05).The differences in the percentages of full early virological response (cEVR),virological response at the end of treatment(ETVR) and continuing virological response(SVR) were not statistically significant between two groups (P＞0.05).The percentages of the increase in neutropenia and ALT were higher,but the percentage of thyroid dysfunction was lower,in group A than those in group B(P＜0.05).There were no significant differences in the incidences of flu-like symptoms,anemia,thrombocytopenia,hair loss and mental disorders between two groups (P＞0.05).Conclusion Compared to Peg-IFN-α-2b combined with RBV,Peg-IFN-α-2a combined with RBV produces a higher RVR rate in the treatment of the patients with CHC.
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