medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2016-14-68-74medsovet-1466Research ArticleЗАБОЛЕВАНИЯ ПЕЧЕНИLIVER DISEASEОпыт лечения больных хроническим вирусным гепатитом С с неблагоприятными предикторами ответаExperience of therapy of chronic viral hepatitis c patients with unfavourable response predictorsГейвандоваН. И.GeyvandovaN. I.

д.м.н., профессор

MD, Prof.

ЛиповА. В.LipovA. V.КоройП. В.KoroyP. V.

д.м.н., профессор

MD, Prof.

ЯгодаА. В.YagodaA. V.

д.м.н., профессор

MD, Prof.

РоговаС. Ш.RogovaS. S.

к.м.н. 

PhD in medicine

Ставропольский государственный медицинский университет Минздрава РоссииРоссияStavropol State Medical University of the Ministry of Health of RussiaRussian Federation2016301220160146874Copyright © Гейвандова Н.И., Липов А.В., Корой П.В., Ягода А.В., Рогова С.Ш., 20162016Гейвандова Н.И., Липов А.В., Корой П.В., Ягода А.В., Рогова С.Ш.Geyvandova N.I., Lipov A.V., Koroy P.V., Yagoda A.V., Rogova S.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/1466

Введение в практику лечебных учреждений РФ противовирусной терапии (ПВТ) хронического вирусного гепатита С (ХВГС) в виде безинтерфероновых схем привело к значительному повышению частоты устойчивого вирусологического ответа (УВО). Цель исследования: определение значения предикторов вирусологического ответа у больных ХВГС при различных схемах лечения. Материал и методы: 1-я группа – 52 больных ХВГС с генотипом 1 HCV получала стандартную ПВТ, 2-я (21 чел.) –  безинтерфероновую схему (препарат Викейра Пак ± рибавирин). Oпределяли генетические полиморфизмы ИЛ-28В rs12979860 (С>Т) и rs8099917 (Т>G) и содержание в крови интерферон-g индуцированного протеина – IP-10. Результаты: стандартная ПВТ в 1-й группе привела к УВО у 29 больных (55,7%). Во 2-й группе, получившей Викейра Пак, был достигнут 100%-ный УВО, несмотря на чаще встречавшиеся F3 и 4-й стадии фиброза, неуспешную ПВТ (9 чел.), противопоказания к препаратам ИФН-α (6 чел.). Неблагоприятные генотипы ИЛ-28В ТТ (rs12979860) и GG (rs8099917) ассо- циировались в 1-й группе с отсутствием УВО, уровень IP-10 у больных с УВО был ниже, чем у нон-респондеров. Терапия препаратом Викейра Пак хорошо переносилась и приводила к УВО, несмотря на наличие тяжелого фиброза/цирроза печени, сопутствующей патологии, неблагоприятных вариантов генотипа ИЛ-28В, высоких уровней белка IP-10. Заключение: выбор оптимальных схем ПВТ для каждого пациента с ХВГС должен проводиться с учетом всех возможных предикторов, что позволит оптимизировать терапию и избежать необходимости повторного лечения. 

Introduction in practice of therapeutic establishments in the RF of antiviral therapy of chronic viral hepatitis in the form of interferon-free schemes led to considerable increase of the frequency of the stable virologic response. Study objective: determination of virologic response predictors in CVHC patients when various therapeutic schemes are used. Materials and methods: Group 1 of CVHC 52 patients with genotype 1 of HCV received standard anti-viral therapy, Group 2 (21 subject) – interferon-free scheme (Viekira Pak+ Ribavirin). Genetic polymorphisms IL-28В rs12979860 (С>Т) and rs8099917 (Т>G) and blood interferon-γ induced protein – IP-10 were determined. Results: standard anti-viral therapy in Group 1 resulted in SVR (sustained viral response) in 29 patients (55.7%). In Group 2 that received Viekira Pak 100% SVR was achieved in spite of more frequent F3 and 4 stage of fibrosis, unsuccessful anti-viral therapy (9 persons), contraindications to IFN-α drugs (6 persons). Unfavorable genotypes IL-28B ТТ (rs12979860) and GG (rs8099917) were associated in Group 1 with lack of SVR, level of IP-10 in patients with SVR was lower than the one in non-respondents. The therapy by Viekira Pak was well tolerated and resulted in SVR despite presence of grave hepatic fibrosis/ cirrhosis, concomitant pathology, unfavourable options of IL-28B, high IP-10 protein levels. Conclusion: choice of optimal anti-viral therapy schemes for each patient with CVHC must be done taken into account all possible predictors, which allows optimizing the therapy and preventing the necessity of repeated therapy. 

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The authors declare that there are no conflicts of interest present.