关键词: 肝炎, 慢性, 丙型, 抗病毒治疗, 病毒学应答, 肝功能

Abstract:

Objective: To explore the changes of liver function in the patients with chronic hepatitis C(CHC)received interferon alpha 2b(INF-α2b)combined with ribavirin therapy,and to study the relationship between the different virological response patterns and liver function. Methods: 264 CHC patients were enrolled. All patients received INF-α2b (5 000 000 U,every other day,subcutaneous injection)combined with ribavirin(15 mg·kg^-1·d^-1,oral)for 48 weeks. The serum HCV RNA level and liver function were assessed at different time points. According to the outcome,the patients were divided into sustained virological response(SVR),breakthrough,relapse and no response(NR)groups. The relationship between the liver function changes and response in the patients with CHC in various groups before and after treatmentwas compared. Results: Among 264 patients,171 patients (64.8%)achieved SVR,37 patients (14.0%)were breakthrough,47 patients(17.8%)were relapse and 9 patients(3.4%)were NR. Compared with breakthrough group,the patients with moderately elevated alanine transaminase(ALT)level in SVR group were easy to achieve SVR than the patients with normal ALT level(P<0.05). After antiviral treatment,the serum ALT and aspartate transaminase (AST)levels were decreased in all patients,especialy at the 12th week and there were significant differences compared with before treatment (P<0.05). The serum ALT and AST levels of the patients in breakthrough group were increased again at the 48th week. In relapse group,the serum ALT and AST levels of the patients were increased again at the 24th week after drug withdrawal. Untill to the 24th week after drug withdrawal,the serum ALT and AST levels were stable in SVR group. Compared with breakthrough group,the serum ALT and AST levels had the greatest reduction at the 12th week in SVR group(P<0.05). The serum ALT and AST levels of the patients in NR group were always higher than those in SVR,breakthrough and relapse groups(P<0.05).Compared with before treatment,the serum total bilirubin(TBIL)and direct bilirubin(DBIL)levels were decreased obviously at the 12th week and maintained stable untill to the 24th week after drug withdrawal in SVR group. At the 24th week,the levels of serum TBIL and DBIL in NR group were significantly higher than those in SVR,breakthrough and relapse groups(P<0.05). Conclusion: The baseline ALT level may associate with the virological response in the CHC. There is an improvement in liver function following antiviral treatment,especially in the patients who achieved SVR.When the HCV have a relapse or breakthrough,transaminase could increase again.

Key words: hepatitis C,chronic, antiviral treatment, virological response, liver function