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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 劉俊人(Chun-Jen Liu) | |
dc.contributor.author | Ming-Yao Chen | en |
dc.contributor.author | 陳明堯 | zh_TW |
dc.date.accessioned | 2021-05-17T09:14:11Z | - |
dc.date.available | 2014-09-19 | |
dc.date.available | 2021-05-17T09:14:11Z | - |
dc.date.copyright | 2012-09-19 | |
dc.date.issued | 2012 | |
dc.date.submitted | 2012-08-17 | |
dc.identifier.citation | 1.O'Brien TR, Everhart JE, Morgan TR, et al. An IL28B genotype-based clinical prediction model for treatment of chronic hepatitis C. PLoS One 2011;6:e20904.
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Predictive value of rapid virological response and early virological response on sustained virological response in HCV patients treated with pegylated interferon alpha-2a and ribavirin. J Gastroenterol Hepatol 2007;22:832-6. 41.Lee H, Choi MS, Paik SW, et al. Peginterferon alfa-2a plus ribavirin for initial treatment of chronic hepatitis C in Korea. The Korean journal of hepatology 2006;12:31-40. 42.Yu ML, Dai CY, Lin ZY, et al. A randomized trial of 24- vs. 48-week courses of PEG interferon alpha-2b plus ribavirin for genotype-1b-infected chronic hepatitis C patients: a pilot study in Taiwan. Liver international : official journal of the International Association for the Study of the Liver 2006;26:73-81. 43.Yu ML, Dai CY, Huang JF, et al. Rapid virological response and treatment duration for chronic hepatitis C genotype 1 patients: a randomized trial. Hepatology 2008;47:1884-93. 44.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. Clin Infect Dis 2008;47:1260-9. 45.Poordad F, McCone J, Jr., Bacon BR, et al. Boceprevir for untreated chronic HCV genotype 1 infection. The New England journal of medicine 2011;364:1195-206. 46.Jacobson IM, McHutchison JG, Dusheiko G, et al. Telaprevir for previously untreated chronic hepatitis C virus infection. The New England journal of medicine 2011;364:2405-16. 47.Bacon BR, Gordon SC, Lawitz E, et al. Boceprevir for previously treated chronic HCV genotype 1 infection. The New England journal of medicine 2011;364:1207-17. 48.Zeuzem S, Andreone P, Pol S, et al. Telaprevir for retreatment of HCV infection. The New England journal of medicine 2011;364:2417-28. 49.Ghany MG, Nelson DR, Strader DB, Thomas DL, Seeff LB. An update on treatment of genotype 1 chronic hepatitis C virus infection: 2011 practice guideline by the American Association for the Study of Liver Diseases. Hepatology 2011;54:1433-44. 50.Jacobson IM, Gonzalez SA, Ahmed F, et al. A Randomized Trial of Pegylated Interferon alpha-2b Plus Ribavirin in the Retreatment of Chronic Hepatitis C. The American Journal of Gastroenterology 2005;100:2453-62. 51.Sherman M, Yoshida EM, Deschenes M, et al. Peginterferon alfa-2a (40KD) plus ribavirin in chronic hepatitis C patients who failed previous interferon therapy. Gut 2006;55:1631-8. 52.Liu CH, Kao JH. Interleukin-28B genetic variations and response to interferon-based therapy: Asian perspectives. J Gastroenterol Hepatol 2011;26:1348-53. 53.Stattermayer AF, Stauber R, Hofer H, et al. Impact of IL28B genotype on the early and sustained virologic response in treatment-naive patients with chronic hepatitis C. Clin Gastroenterol Hepatol 2011;9:344-50 e2. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/6493 | - |
dc.description.abstract | 慢性C型肝炎感染(chronic hepatitis C, CHC)是造成失償性肝硬化以及肝細胞癌的主要原因之一。為期48週的長效干擾素合併依體重調整的雷巴威林是亞太地區當今治療第一型慢性C型肝炎的標準治療,然而,約只有60-70%患者可以達成持續病毒學反應(SVR)。在從未治療過的患者中,IL28B附近的單一核苷酸多形性(SNP)與是否會自發性痊癒或者經治療而清除病毒有關。但是對於台灣人之慢性C型肝炎的復發者(relapser)而言,當今標準治療的效果以及IL28B SNP的影響均不明瞭。
在台灣,吾人從2009年收錄了103位慢性C型肝炎的復發者。吾人進行48週的長效干擾素及雷巴威林的合併治療,評估IL28B SNP以及治療過程中的病毒動力學變化以及生化反應。其中僅納入75位(73%)的第一基因型慢性C型肝炎患者進行分析研究。整體而言,治療中的病毒動力學變化針對快速病毒學反應(RVR)、治療結束病毒反應(EOT-VR)與SVR而論,分別為37%、73%與52%。復發率則為29%。若能達成RVR,則有較高的機率可以達成SVR (P<0.0001) 以及較低的復發率(P=0.0034)。與GT IL28B基因型相比,TT的患者有較高的RVR (P=0.0002)、EOT-VR (P=0.0001)以及 SVR (P<0.0001)的機會。若合併第四週病毒轉陰化(week 4 viral negativity,即RVR)與IL28B基因型,則判別SVR的陽性與陰性預測值(PPV, NPV)與第12週時的病毒轉陰化效果相當。 運用當今標準治療來醫治台灣的第一基因型慢性C型肝炎復發者,約有半數可以達成持續病毒學反應。IL28B SNP會影響再次治療中的病毒動力學變化,SVR以及復發率。將來若能依據IL28B SNP以及RVR的變化,或許可進行個人化的治療,甚至可以當成早期停藥的指標。 | zh_TW |
dc.description.abstract | Chronic hepatitis C infection (CHC) is a leading cause of decompensated cirrhosis and hepatocellular carcinoma. Forty-eight-weekly pegylated interferon (PEG-IFN)plus weight-based ribavirin (RBV) has been the current standard of care (SOC) for CHC genotype 1 in Asia-Pacific region and can only achieve an overall sustained virologic response (SVR) of 60-70%.The single nucleotide polymorphism (SNP) near the interleukin-28B (IL28B) is associated with spontaneous or treatment-induced viral clearance in untreated patients. It remains unclear for the efficacy of current SOC and influence of IL28B SNP in re-treating Taiwan CHC relapsers.
In Taiwan, since November 2009, we consecutively enrolled 103 CHC relapsers into this study. We evaluated the IL28B SNPs, virologic kinetics, and biochemical responses of CHC patients receiving 48-weekPEG-IFN plus RBV. Only 75 CHC genotype 1 relapsers (73%) were included for analysis. The overall viral kinetics was 37%,73% and 52% in rapid virologic response (RVR), end-of-treatment viral response (EOT-VR) and SVR respectively. Relapse rate was 29%.Patient with TT IL28B had higher rate of RVR (P=0.0002), EOT-VR (P=0.0001) and SVR (P<0.0001) in comparison with GT. Achieving a RVR ensured a higher SVR rate (P<0.0001) and lower relapse rate (P=0.0034). In combination of week 4 viral negativity (i.e. RVR) with IL28B genotype, a high positive and negative predictive value of SVR achieved as equally good as week 12 viral negativity. About half of the CHC relapsers in Taiwan would achieve SVR under current SOC. IL28B SNP would influence the on-treatment viral kinetics, SVR and relapse rate in retreatment. There might be the individualized therapy according to the IL28B SNP and RVR in the future, especially the early stopping rule. | en |
dc.description.provenance | Made available in DSpace on 2021-05-17T09:14:11Z (GMT). No. of bitstreams: 1 ntu-101-P99421005-1.pdf: 2903563 bytes, checksum: 5c6599255c9fe9ebd55c32b77b0740ea (MD5) Previous issue date: 2012 | en |
dc.description.tableofcontents | 口試委員會審定書……………………………………… i
誌謝………………………………………………………… ii 中文摘要…………………………………………………… iii 英文摘要…………………………………………………… iv 碩士論文內容 第一章 緒論……………………………………………… 1 第二章 研究方法與材料………………………………… 7 2.1 計畫目的……………………………………………… 7 2.2 實施方法及進行步驟………………………………… 7 2.3 研究設計……………………………………………… 8 2.4 實驗診斷……………………………………………… 9 2.5 安全評估………………………………………………10 2.6 調整藥物劑量或中止治療……………………………11 2.7 臨床上不良反應及處理方法…………………………11 2.8 統計分析………………………………………………13 第三章 結果 3.1 研究對象之特徵………………………………………15 3.2 病毒動力學反應—治療進行中、治療結束後24週的持續病毒學反應與復發……………………………16 3.3 依治療中的病毒動力學變化(第4及12週)以及IL28B SNPs分型來探討持續病毒學反應與復發……16 3.4 與快速病毒學反應及持續病毒學反應相關因素的探討……………………………………………………17 3.5 以IL28B SNP 與治療中病毒動力學變化來預測持續病毒學反應…………………………………………18 第四章 討論………………………………………………20 第五章 展望………………………………………………23 第六章 英文論文簡述……………………………………25 第七章 參考文獻…………………………………………45 第八章 圖表………………………………………………50 | |
dc.language.iso | zh-TW | |
dc.title | IL28B基因多形性對於慢性C型肝炎感染之再次治療結果的預測價值 | zh_TW |
dc.title | Predictive Value of IL28B Gene Polymorphisms on Retreatment Outcome of Chronic Hepatitis C | en |
dc.type | Thesis | |
dc.date.schoolyear | 100-2 | |
dc.description.degree | 碩士 | |
dc.contributor.coadvisor | 高嘉宏(Jia-Horng Kao) | |
dc.contributor.oralexamcommittee | 楊宏志(Hung-Chih Yang) | |
dc.subject.keyword | 慢性C型肝炎,長效型干擾素,IL28B,再治療, | zh_TW |
dc.subject.keyword | chronic hepatitis C,pegylated interferon,IL28B,retreatment, | en |
dc.relation.page | 69 | |
dc.rights.note | 同意授權(全球公開) | |
dc.date.accepted | 2012-08-17 | |
dc.contributor.author-college | 醫學院 | zh_TW |
dc.contributor.author-dept | 臨床醫學研究所 | zh_TW |
顯示於系所單位: | 臨床醫學研究所 |
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