难治性丙型肝炎HCV基因型临床特征及芪术冲剂抗病毒疗效观察
Clinical Characteristics of HCV Genotype of Refractory Hepatitis C and its Effect on Antiviral Function of Qizhu Granule
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摘要: 目的 探讨难治性丙型肝炎HCV基因型临床特征及芪术冲剂抗病毒疗效观察。方法 将入组的204例难治性丙型肝炎患者采用SANGER测序法进行病毒基因型分析，并按1∶1比例随机分为治疗组和对照组，治疗组予芪术冲剂（治疗过程中的兼夹证进行固定药物和固定剂量的随证加味）治疗，对照组予安慰剂，治疗疗程均为48周。在第0周（治疗前）、第4周、第12周、第24周、第48周（治疗后）、第72周检测HCV RNA定量。结果 在完成48周治疗的182例病例中，173例检测得基因型，其中1b型为129例，占74.6%，非1b型占26.4%。1b型和非1b型患者在性别、BMI指数及血清ALT、AST基础水平上差异无统计学意义（P＞0.05），但1b型患者的病程要长于非1b型，年龄要大于非1b型，HCV RNA基础水平要高于非1b型，差别有统计学意义（P＜0.05）。芪术冲剂治疗组中非1b型患者的持续病毒学应答（SVR）率为42.86%，而1b型患者的SVR率仅为9.09%，两者差异有统计学意义（P＜0.05）。结论 HCV基因非1b型患者对芪术冲剂有更好的抗病毒应答，HCV基因型对中药复方抗病毒学应答存在影响。Abstract: OBJECTIVE To investigate clinical characteristics of HCV genotypes of refractory hepatitis C and its effect on antiviral function of Qizhu Granule. METHODS After virus genotypes were analyzed by SANGER sequencing before the treatment， 204 patients with refractory hepatitis C were randomly and equally divided into the treatment group (Qizhu Granules) and the control group (placebo group). Two groups received 48-week treatments. The patients' HCV RNA level was monitored before treatment and during the 4th， 12th， 24th， 48th treatment， as well as 4 weeks after the treatment. RESULTS 182 patients finally received 48-week treatment and completed the study.173 cases were detected with their genotypes， including 129 case of genotype 1b for 74.6%， and 44 cases of non-1b type for 26.4%. No significant difference was found between genotype 1b and non-genotype 1b patients in gender， BMI index and serum ALT and AST level (P>0.05). Patients infected by genotype 1b virus had longer disease courses and were older than non-genotype 1b patients on average. RNA level of HCV of genotype 1b patients was higher than that of non-1b type with significant differences. SVR in the treatment group of non-genotype 1b patients was 42.86%， while that of genotype 1b was only 9.09% with statistically significance. CONCLUSION Non-1b genotype patients have better antiviral effects and HCV genotype is an important factor affecting the antiviral effect of Qizhu granules.
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Key words:
- refractory diseases /
- hepatitis C /
- Qizhu Granules /
- genotype
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