持续性病毒学应答与丙肝病毒RNA的清除和丙肝病毒抗体降低有关

　　摘要

　　背景/目的：经过干扰素治疗后慢性丙肝患者的病毒清除达到持续性病毒学应答，仍然存在争论。

　　方法：在一段长期的跟踪研究中，157个用干扰素治疗，达到持续性病毒学应答的患者接受血清TMA分析检测。丙肝抗体通过检测OD和丙肝抗体的半定量滴定度进行分析。对照组包括23个没有进行治疗的转氨酶正常和可检测丙肝RNA的患者。

　　结果：跟踪的平均值是4年。在所有患者中仍无法检测到丙肝RNA，平均丙肝抗体OD值在治疗前后分别是93 ± 19 和 45 ± 21(P = 0.001)。对于NS3, NS4 和NS5出现显著降低，但对于核蛋白却仍然呈现阳性。对23个对照病人进行跟踪监测的时间平均是5年，治疗前后丙肝抗体OD平均值分别是65 ± 14 和 64 ± 19，结构和非结构蛋白的丙肝抗体滴度仍无显著改变。

　　结论：这个对157为患者进行的长期研究说明TMA应答分析是经得起考验的，丙肝抗体显著降低，继续感染的可能性很低。这个结果说明获得应答的丙肝患者是可以治愈的。

　　原文： 

　　Sustained Virological Response Is Associated with Clearance of Hepatitis C Virus RNA and a Decrease in Hepatitis C Virus Antibody

　　Association With Clearance of HCV RNA and a Decrease in HCV Antibody

　　Sarah Maylin; Michelle Martinot-Peignoux; Marie-Pierre Ripault; Rami Moucari; Ana Carolina Cardoso; Nathalie Boyer; Nathalie Giuily; Corinne Castelnau; Michelle Pouteau; Tarik Asselah; Marie Hélìne Nicolas-Chanoine; Patrick Marcellin

　　Authors and Disclosures

　　Background/Aim: Viral eradication in chronic hepatitis C patients with sustained virological response (SVR) after interferon (IFN) therapy remains controversial.

　　Methods: During a long-term follow-up study, 157 patients with SVR to IFN-α-2b-based therapy were investigated with a transcription-mediated amplification (TMA) assay in serum. The hepatitis C virus (HCV) antibody was assessed by measuring the optical density (OD) (Axsym HCV v3.0) and the semiquantitative titres (RIBA HCV v3.0) of the HCV antibodies directed against the core, NS3, NS4 and NS5 proteins. A control group included 23 untreated patients with persistently normal serum alanine aminotransferase and detectable serum HCV-RNA.

　　Results: The median duration of follow-up was 4.0 (0-10) years. Serum HCV-RNA remained undetectable in all patients. The mean HCV antibody OD were 93 ± 19 and 45 ± 21 before therapy and in the last available serum sample respectively (P = 0.001). There was a marked decrease in the HCV antibodies directed against the NS3, NS4 and NS5 proteins (P = 0.001), while the core protein titre remained strongly positive. The 23 control patients were followed for a median of 5 (2-14) years. The mean HCV antibody OD were 65 ± 14 and 64 ± 19 in the first and the last measurements, respectively (NS), and HCV antibody titres for structural and non-structural proteins remained unchanged.

　　Conclusion: This long-term study evaluating 157 patients demonstrated that SVR assessed by TMA is durable, and HCV antibodies were markedly decreased (mainly those directed against the non-structural proteins), emphasizing an absence of ongoing infection. These results strongly suggest that HCV infection cured in patients who achieve an SVR.