摘要目的 探讨HBV和HCV合并感染患者的临床特征及对聚乙二醇干扰素α-2a(PEGIFNα-2a)联合利巴韦林抗病毒疗效的影响.方法 对39例HBV和HCV合并感染患者的流行病学和病毒学资料进行回顾性分析,并观察PEGIFNα-2a联合利巴韦林治疗的病毒学应答情况.数据行χ~2检验和t检验.结果 39例HBV和HCV合并感染患者中,HCV优势株型35例,占89.7%;HBV和HCV混合优势株型4例,占10.3%.39例合并感染组患者HBeAg阳性率为15.4%,明显低于42例单纯HBV感染者的45.3%(χ~2=8.446,P=0.004).合并感染组患者的HBV DNA平均值为(4.6±O.9)lg拷贝/mL,,明显低于单纯HBV感染组的(5.9±1.2)lg拷贝/mL(t=5.544,P<0.01).在29例基因1型患者中,合并感染组的部分早期病毒学应答率为51.7%,明显高于25例单纯HCV感染组的24.0%(χ~2=4.432,P=0.037);治疗结束时病毒学应答率为93.1%,也明显高于HCV感染组的56.0%(χ~2=10.112,P=0.001);复发率为55.6%,也明显高于HCV感染组的21.4%(χ~2=4.360,P=0.037).非基因1型患者中,合并感染组与HCV感染组的快速病毒学应答、完全早期病毒学应答、部分早期病毒学应答、治疗结束时病毒学应答、持续病毒学应答和复发率相比差异无统计学意义(P>0.05).合并感染组39例患者中有15例出现不良反应,占38.5%,单纯HCV感染组25例患者中有6例出现不良反应,占17.6%(χ~2=3.851,P=0.049).结论 HBV和HCV合并感染以HCV为优势病毒株,HBV复制受抑制.与单纯HCV感染相比.基因1型患者部分早期病毒学应答、治疗结束时病毒学应答和复发率高,持续病毒学应答相似;合并感染对非基因1型病毒学应答率无影响.

abstractsObjective To study the clinical features of patients co-infected with hepatitis B virus (HBV) and hepatitis C virus (HCV) and the impact of co-infection on the efficacy of peginterferon and ribavirin treatments. Methods The virological responses to peginterferon and ribavirin treatment in 39 HBV and HCV co-infected patients were retrospectively analyzed. The data were analyzed by χ~2 test and t test. Results Among the 39 co-infected patients, HCV strains were dominant in 35 patients (89. 7%), while HCV and HBV strains were both dominant in 4 patients (10. 3%). HBeAg positive rate in co-infected patients(n = 39) was significantly lower than that in HBV mono-infected group (n= 42,15.4% vs45.3%, χ~2=8.446, P = 0.004). HBV DNA level in co-infected patients was (4. 6±0. 9) lg copy/mL compared to (5. 9±1. 2)lg copy/mL in HBV mono-infected group (t=5. 544, P < 0. 01). Partial early virological response (pEVR) rates and end treatment virological response (ETVR) rates were significantly higher in patients co-infected with genotype 1 of HCV and HBV (n = 29) than those in HCV mono-infected patients (n = 25, 5. 7% vs 24. 0%, χ~2 =4. 432 P = 0. 037; 93.1% vs 56. 0%,χ~2 = 10. 112, P = 0. 001). However, relapse rate in patients co-infected with genotype 1 of HCV and HBV was also significantly higher than that in HCV mono-infected patients (55. 6% vs 21. 4% χ~2 =4. 360, P = 0. 037). There were no significant differences in term of rapid virological response (RVR), complete early virological response (cEVR), pEVR, ETVR, sustain virological response (SVR) and relapse between patients co-infected with non-genotype 1 of HCV and HBV and patients mono-infected with non-genotype 1 of HCV. The incidence of side events in co infected patients was significantly higher than that in HCV mono-infected patients (38. 5% vs 17. 6% χ~2= 3.851, P = 0. 049). Conclusions HCV strains are dominant in HCV and HBV co-infected patients. HBV replication is suppressed in this patient population. pEVR, ETVR and relapse rates of patients co-infected with genotype 1 of HCV and HBV are higher than those in HCV mono-infected patients, whereas SVR rates are similar between these two groups. Co-infection with HBV and non genotype 1 of HCV has no impact on virological responses to anti-HCV treatment.