• 四川大學(xué)華西醫(yī)院感染性疾病中心（成都，610041）;

丙型肝炎病毒感染后大多數(shù)患者轉(zhuǎn)為慢性感染，若不及時正確地進(jìn)行治療，相當(dāng)比例患者會產(chǎn)生嚴(yán)重臨床后果，丙型肝炎患者一旦確診應(yīng)積極行抗病毒治療。根據(jù)病毒基因型及患者治療過程中病毒學(xué)應(yīng)答情況來預(yù)測療效并相應(yīng)調(diào)整治療方案，成為目前抗病毒治療的研究熱點(diǎn)。

引用本文： 郭麗琳,雷學(xué)忠. 慢性丙型肝炎抗病毒治療個體化療程選擇. 華西醫(yī)學(xué), 2012, 27(9): 1431-1433. doi: 復(fù)制

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1. 　Firpi RJ, Clark V, Soldevila-Pico C, et al. The natural history of hepatitis C cirrhosis after liver transplantation[J]. Liver Transpl, 2009, 15(9): 1063-1071.
2. 　慢性丙型肝炎抗病毒治療專家委員會. 慢性丙型肝炎抗病毒治療專家共識[J]. 中華實(shí)驗和臨床感染病雜志·電子版, 2009, 3(3): 343-352.
3. 　Sánchez-Tapias JM, Diago M, Escartín P, et al. Peginterferon-alfa2a plus ribavirin for 48 versus 72 weeks in patients with detectable hepatitis C virus RNA at week 4 of treatment[J]. Gastroenterology, 2006, 131(2): 451-460.
4. 　Ghany MG, Strader DB, Thomas DL, et al. Diagnosis, management, and treatment of hepatitis C: an update[J]. Hepatology, 2009, 49(4): 1352-1374.
5. 　Yu ML, Dai CY, Huang JF, et al. Rapid virological response and treatment duration for chronic hepatitis C genotype 1b infected chronic hepatitis C patients:a randomised trial[J]. Hepatology, 2008, 47(6): 1884-1893.
6. 　Liu CH, Liu CJ, Lin CL, et al. Pegylated interferon-alpha-2a plus ribavirin for treatment-naive Asian patients with hepatitis C virus genotype 1 infection: a multicenter, randomized controlled trial[J]. Clin Infect Dis, 2008, 47(10): 1260-1269.
7. 　Berg T, Weich V, Teuber G, et al. Individualized treatment strategy according to early viral kinetics in hepatitis C virus type 1-infected patients[J]. Hepatology, 2009, 50(2): 369-377.
8. 　Moreno C, Deltenre P, Pawlotsky JM, et al. Shortened treatment duration in treatment-naive genotype 1 HCV patients with rapid virological response: a meta-analysis[J]. J Hepatol, 2010, 52(1): 25-31.
9. 　Berg T, von Wagner M, Nasser S, et al. Extended treatment duration for hepatitis C virus type 1: comparing 48 versus 72 weeks of peginterferon-alfa-2a plus ribavirin[J]. Gastroenterology, 2006, 130(4): 1086-1097.
10. 　Pearlman BL, Ehleben C, Saifee S. Treatment extension to 72 weeks of peginterferon and ribavirin in hepatitis c genotype 1-infected slow responders[J]. Hepatology, 2007, 46(6): 1688-1694.
11. 　Farnik H, Lange CM, Sarrazin C, et al. Meta-analysis shows extended therapy improves response of patients with chronic hepatitis C virus genotype 1 infection[J]. Clin Gastroenterol Hepatol, 2010, 8(10): 884-890.
12. 　成軍. 慢性丙型肝炎治療的新進(jìn)展[J]. 中華實(shí)驗和臨床感染病雜志: 電子版, 2010, 4(1): 1-5.
13. 　Ide T, Hino T, Ogata K, et al. A randomized study of extended treatment with peginterferon alpha-2b plus ribavirin based on time to HCV RNA negative-status in patients with genotype 1b chronic hepatitis C[J]. Am J Gastroenterol, 2009, 104(1): 70-75.
14. 　Chayama K, Hayes CN, Yoshioka K, et al. Factors predictive of sustained virological response following 72 weeks of combination therapy for genotype 1b hepatitis C[J]. J Gastroenterol, 2011, 46(4): 545-555.
15. 　Mangia A, Minerva N, Bacca D, et al. Individualized treatment duration for hepatitis C genotype 1 patients: A randomized controlled trial[J]. Hepatology, 2008, 47(1): 43-50.
16. 　European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Management of hepatitis C virus infection[J]. Hepatology, 2011 ,55(2): 245-264.
17. 　Shiffman ML, Suter F, Bacon BR, et al. Peginterferon alfa-2a and ribavirin for 16 or 24 weeks in HCV genotype 2 or 3[J]. N Engl J Med, 2007, 357(2): 124-134.
18. 　Dalgard O, Bjøro K, Ring-Larsen H, et al. A randomized controlled trial of pegylated interferon alfa and ribavirin for 14 vs 24 weeks in patients with HCV genotype 2 or 3 and rapid virological response[J]. Hepatology, 2008, 47(1): 35-42.
19. 　Yu ML, Dai CY, Huang JF, et al. A randomised study of peginterferon and ribavirin for 16 versus 24 weeks in patients with genotype 2 chronic hepatitis C[J]. Gut, 2007, 56(4): 553-559.
20. 　Kau A, Vermehren J, Sarrazin C. Treatment predictors of a sustained virologic response in hepatitis B and C[J]. J Hepatol, 2008, 49(4): 634-651.
21. 　Romero-Gómez M, Fernández-Rodríguez CM, Andrade RJ, et al. Effect of sustained virological response to treatment on the incidence of abnormal glucose values in chronic hepatitis C[J]. J Hepatol, 2008, 48(5): 721-727.
22. 　Mangia A, Minerva N, Bacca D, et al. Determinants of relapse after a short (12 weeks) course of antiviral therapy and re-treatment efficacy of a prolonged course in patients with chronic hepatitis C virus genotype 2 or 3 infection[J]. Hepatology, 2009, 49(2): 358-363.
23. 　Lagging M, Langeland N, Pedersen C, et al. Randomized comparison of 12 or 24 weeks of peginterferon alpha 2a and ribavirin in chronic hepatitis C virus genotype 2/3 infection[J]. Hepatology, 2008, 47(6): 1837-1845.
24. 　Willems B, Hadziyannis SJ, Morgan TR, et al. Should treatment with peginterferon plus ribavirin be intensified in patients with HCV genotype 2/3without a rapid virologic response[J]. Hepatol, 2007, 46(Suppl 1): S6.
25. 　Shiffman ML, Minola E, Barange K, et al. Characterisation of HCV genotype 2/3 patients without a rapid virological response (RVR) optimising treatment by predicting slower responders to peginterferon a2a plus ribavirin[J]. Hepatol, 2007, 46(Suppl 1): S245.
26. 　Lam KD, Trinh HN, Do ST, et al. Randomized controlled trial of pegylated interferon-alfa 2a and ribavirin in treatment-naive chronic hepatitis C genotype 6[J]. Hepatology, 2010, 52(5): 1573-1580.
27. 　Zhou YQ, Wang XH, Hong GH, et al. Twenty-four weeks of pegylated interferon plus ribavirin effectively treat patients with HCV genotype 6a[J]. J Viral Hepat, 2011, 18(8): 595-600.
  1. 1. 　Firpi RJ, Clark V, Soldevila-Pico C, et al. The natural history of hepatitis C cirrhosis after liver transplantation[J]. Liver Transpl, 2009, 15(9): 1063-1071.
  2. 2. 　慢性丙型肝炎抗病毒治療專家委員會. 慢性丙型肝炎抗病毒治療專家共識[J]. 中華實(shí)驗和臨床感染病雜志·電子版, 2009, 3(3): 343-352.
  3. 3. 　Sánchez-Tapias JM, Diago M, Escartín P, et al. Peginterferon-alfa2a plus ribavirin for 48 versus 72 weeks in patients with detectable hepatitis C virus RNA at week 4 of treatment[J]. Gastroenterology, 2006, 131(2): 451-460.
  4. 4. 　Ghany MG, Strader DB, Thomas DL, et al. Diagnosis, management, and treatment of hepatitis C: an update[J]. Hepatology, 2009, 49(4): 1352-1374.
  5. 5. 　Yu ML, Dai CY, Huang JF, et al. Rapid virological response and treatment duration for chronic hepatitis C genotype 1b infected chronic hepatitis C patients:a randomised trial[J]. Hepatology, 2008, 47(6): 1884-1893.
  6. 6. 　Liu CH, Liu CJ, Lin CL, et al. Pegylated interferon-alpha-2a plus ribavirin for treatment-naive Asian patients with hepatitis C virus genotype 1 infection: a multicenter, randomized controlled trial[J]. Clin Infect Dis, 2008, 47(10): 1260-1269.
  7. 7. 　Berg T, Weich V, Teuber G, et al. Individualized treatment strategy according to early viral kinetics in hepatitis C virus type 1-infected patients[J]. Hepatology, 2009, 50(2): 369-377.
  8. 8. 　Moreno C, Deltenre P, Pawlotsky JM, et al. Shortened treatment duration in treatment-naive genotype 1 HCV patients with rapid virological response: a meta-analysis[J]. J Hepatol, 2010, 52(1): 25-31.
  9. 9. 　Berg T, von Wagner M, Nasser S, et al. Extended treatment duration for hepatitis C virus type 1: comparing 48 versus 72 weeks of peginterferon-alfa-2a plus ribavirin[J]. Gastroenterology, 2006, 130(4): 1086-1097.
  10. 10. 　Pearlman BL, Ehleben C, Saifee S. Treatment extension to 72 weeks of peginterferon and ribavirin in hepatitis c genotype 1-infected slow responders[J]. Hepatology, 2007, 46(6): 1688-1694.
  11. 11. 　Farnik H, Lange CM, Sarrazin C, et al. Meta-analysis shows extended therapy improves response of patients with chronic hepatitis C virus genotype 1 infection[J]. Clin Gastroenterol Hepatol, 2010, 8(10): 884-890.
  12. 12. 　成軍. 慢性丙型肝炎治療的新進(jìn)展[J]. 中華實(shí)驗和臨床感染病雜志: 電子版, 2010, 4(1): 1-5.
  13. 13. 　Ide T, Hino T, Ogata K, et al. A randomized study of extended treatment with peginterferon alpha-2b plus ribavirin based on time to HCV RNA negative-status in patients with genotype 1b chronic hepatitis C[J]. Am J Gastroenterol, 2009, 104(1): 70-75.
  14. 14. 　Chayama K, Hayes CN, Yoshioka K, et al. Factors predictive of sustained virological response following 72 weeks of combination therapy for genotype 1b hepatitis C[J]. J Gastroenterol, 2011, 46(4): 545-555.
  15. 15. 　Mangia A, Minerva N, Bacca D, et al. Individualized treatment duration for hepatitis C genotype 1 patients: A randomized controlled trial[J]. Hepatology, 2008, 47(1): 43-50.
  16. 16. 　European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Management of hepatitis C virus infection[J]. Hepatology, 2011 ,55(2): 245-264.
  17. 17. 　Shiffman ML, Suter F, Bacon BR, et al. Peginterferon alfa-2a and ribavirin for 16 or 24 weeks in HCV genotype 2 or 3[J]. N Engl J Med, 2007, 357(2): 124-134.
  18. 18. 　Dalgard O, Bjøro K, Ring-Larsen H, et al. A randomized controlled trial of pegylated interferon alfa and ribavirin for 14 vs 24 weeks in patients with HCV genotype 2 or 3 and rapid virological response[J]. Hepatology, 2008, 47(1): 35-42.
  19. 19. 　Yu ML, Dai CY, Huang JF, et al. A randomised study of peginterferon and ribavirin for 16 versus 24 weeks in patients with genotype 2 chronic hepatitis C[J]. Gut, 2007, 56(4): 553-559.
  20. 20. 　Kau A, Vermehren J, Sarrazin C. Treatment predictors of a sustained virologic response in hepatitis B and C[J]. J Hepatol, 2008, 49(4): 634-651.
  21. 21. 　Romero-Gómez M, Fernández-Rodríguez CM, Andrade RJ, et al. Effect of sustained virological response to treatment on the incidence of abnormal glucose values in chronic hepatitis C[J]. J Hepatol, 2008, 48(5): 721-727.
  22. 22. 　Mangia A, Minerva N, Bacca D, et al. Determinants of relapse after a short (12 weeks) course of antiviral therapy and re-treatment efficacy of a prolonged course in patients with chronic hepatitis C virus genotype 2 or 3 infection[J]. Hepatology, 2009, 49(2): 358-363.
  23. 23. 　Lagging M, Langeland N, Pedersen C, et al. Randomized comparison of 12 or 24 weeks of peginterferon alpha 2a and ribavirin in chronic hepatitis C virus genotype 2/3 infection[J]. Hepatology, 2008, 47(6): 1837-1845.
  24. 24. 　Willems B, Hadziyannis SJ, Morgan TR, et al. Should treatment with peginterferon plus ribavirin be intensified in patients with HCV genotype 2/3without a rapid virologic response[J]. Hepatol, 2007, 46(Suppl 1): S6.
  25. 25. 　Shiffman ML, Minola E, Barange K, et al. Characterisation of HCV genotype 2/3 patients without a rapid virological response (RVR) optimising treatment by predicting slower responders to peginterferon a2a plus ribavirin[J]. Hepatol, 2007, 46(Suppl 1): S245.
  26. 26. 　Lam KD, Trinh HN, Do ST, et al. Randomized controlled trial of pegylated interferon-alfa 2a and ribavirin in treatment-naive chronic hepatitis C genotype 6[J]. Hepatology, 2010, 52(5): 1573-1580.
  27. 27. 　Zhou YQ, Wang XH, Hong GH, et al. Twenty-four weeks of pegylated interferon plus ribavirin effectively treat patients with HCV genotype 6a[J]. J Viral Hepat, 2011, 18(8): 595-600.