| Objective To analysize the influence factors that cause the treatment failure of interferon alfa-2b combining with ribavirin in patients with hepatitis C virus genotype 1b. For those who suffer from treatment failure, they were given therapeutic schedule of peginterferon alfa-2a combining with ribavirin, the curative effect of whom was evaluated,in order to provid effective reference for individualized treatment plan in the clinical work.Methods Retrospective and prospective analysis methods were adopted in this study and 282 patients with gene 1b chronic hepatitis C that had received IFN?-2b combining RBV as the primary anti-viral treatment plan from January 2011- December 2014 in the outpatient and inpatient department of Infectious Disease Department in First Affiliated Hospital of Zhengzhou University were taken as the study objects. Patients who had turned negative in 12 weeks of treatment and the virus was not resilient were divided into the treatment effective group(205 cases) and patients who did not turn negative in 12 weeks of treatment or the virus was resilient were divided into thetreatment failure group(77 cases). Single factor analysis was conducted on factors that may influence the treatment, including gender, age, IL-28 B gene-type, HCV RNA loads, ALT level, diabetes, hepatic steatosis, blood transfusion history, and multi-factor logistic regression analysis was conducted on factors with statistical significance. Independent influencing factors that were related to treatment failure were analyzed. Patients(58 cases) who had received IFN?-2b combining RBV treatment and did not turn negative in 12 weeks or the virus was resilient, and continued PEG IFN?-2a combining RBV treatment were divided into the virus poor response group(21 cases) and the virus relapse group(37 cases). The rapid virus response rate(RVR), complete early virus response rate(c EVR), sustained virus response rate(SVR) were compared to evaluate the curative effect and difference.Results 1.(1) The failure rate of patients with age ?50 was higher than that of patients with age<50(P = 0.028);(2) the failure rate of IL-28 B gene non-dominant group was evidently higher than that of IL-28 B gene dominant group(P<0.001);(3) the failure rate of patients with HCV RNA loads?105IU/ml was higher than that of patients with HCV RNA loads <105IU/ml(P=0.038);(4) the failure rate of patients with diabetes was higher than that of patients without diabetes(P=0.014);(5) Gender, whether ALT level higher than 80U/L, whether there was a blood transfusion history had no statistical significance(P>0.05). Multi-factor logistic regression analysis found that: age ?50(OR:2.474,P=0.032), IL-28 B gene non-dominant type(OR:6.364,P<0.001), HCV RNA?105IU/ml(OR:3.167,P=0.021), complicating with diabetes(OR:2.215, P=0.041) are independent influencing factors of the treatment failure of normal interferon ?-2b combining ribavirin. 2. Among patients that had failed in IFN?-2b combining RBV antiviral treatment and received PEG IFN?-2a combining RBV treatment, RVR of the virus relapse group and poor response group were separately 70.27%(26/37), 33.33%(7/21) and the difference had statistical significance(P=0.006); c EVR were separately 78.38%(29/37), 38.10%(8/21) and the difference was statistically difference(P =0.002); SVR were separately 59.46%(22/37), 23.73%(5/21) and the difference was statistically significant(P = 0.009).Conclusions 1. Age ?50, IL-28 B gene non-dominant,HCV RNA loads?105IU/ml and complicated with diabetes are independent influence factors that cause treatment failure of interferon alfa-2b combining with ribavirin among the patients with hepatitis C virus genotype 1b. 2. Among the patients suffering from treatment failure of interferon alfa-2b combining with ribavirin and continuing peginterferon alfa-2a combining with ribavirin treatment, the curative effect of the virus relapse group was evidently better than that of the poor response group. |
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