Dokument: Einfluss einer antiviralen Therapie auf Komplikationen und die Mortalität von chro-nischen Hepatitis C-Patienten unter Berücksichtigung von klinischen, laborchemischen und histologischen Parametern
| Titel: | Einfluss einer antiviralen Therapie auf Komplikationen und die Mortalität von chro-nischen Hepatitis C-Patienten unter Berücksichtigung von klinischen, laborchemischen und histologischen Parametern | |||||||
| URL für Lesezeichen: | https://docserv.uni-duesseldorf.de/servlets/DocumentServlet?id=21601 | |||||||
| URN (NBN): | urn:nbn:de:hbz:061-20120613-111326-0 | |||||||
| Kollektion: | Dissertationen | |||||||
| Sprache: | Deutsch | |||||||
| Dokumententyp: | Wissenschaftliche Abschlussarbeiten » Dissertation | |||||||
| Medientyp: | Text | |||||||
| Autor: | Köhler, Gerald [Autor] | |||||||
| Dateien: |
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| Beitragende: | Prof. Dr. med Heintges, Tobias [Betreuer/Doktorvater] Prof. Dr. Germing, Ulrich [Gutachter] Prof. Dr. Flohé, Sascha [Gutachter] | |||||||
| Stichwörter: | Hepatitis C | |||||||
| Dewey Dezimal-Klassifikation: | 600 Technik, Medizin, angewandte Wissenschaften » 610 Medizin und Gesundheit | |||||||
| Beschreibung: | Einführung: Die aktuelle Standardtherapie ist eine Kombinationstherapie aus pegyliertem Interferon und Ribavirin. Die Ansprechraten sind jedoch immer noch unbefriedigend, bei Genotyp 1 werden derzeit nur Ansprechraten von ca. 50% erreicht. Die vorliegende Studie untersucht mögliche Prognosefaktoren für ein Therapieansprechen und die Entwicklung von Komplikationen.
Patienten: In einer retrospektiven Studie mit 1036 Patienten wurde über einen Beobachtungsraum von durchschnittlich 64 Monaten der natürliche Verlauf einer chronischen Hepatitis C mit therapierten Patienten verglichen. Hierbei wurde der Einfluss von verschiedenen Kovariaten auf das Therapieansprechen, die Entwicklung von Komplikationen und das Auftreten von leberbedingten Todesfällen untersucht. 507 Patienten erhielten eine Therapie, bei 529 Patienten wurde keine Therapie durchgeführt. Resultate: Die Ansprechrate lag für alle Patienten bei 22,3%, zu einem Relaps kam es bei 23,7%. Nonresponder machten einen Anteil von 54% aus. In der multivariaten Korrelationsanalyse mithilfe des Coxregressionsmodells zeigte sich eine signifikante Korrelation des Patientenalters , des Sonographiebefundes, des histologischen Stagings, des Albuminwertes und der Thrombozytenzahl mit der Entwicklung von Komplikationen sowie eine signifikante Korrelation des Patientenalters, des Geschlechts, des Sonographiebefundes, des histologischen Stagings, des Albuminwertes und der Thrombozytenzahl bzw. dem Auftreten von Todesfällen. In einer weiteren Analyse ergaben sich als signifikante Kovariaten für ein Nichtansprechen auf eine Therapie ein Patientenalter > 50 Jahre, ein erhöhter Ferritinwert sowie ein erniedrigter Albuminwert bzw. eine erniedrigte Thrombozytenzahl Diskussion: In dieser Arbeit konnte gezeigt werden, dass ein signifikanter Zusammenhang zwischen den Laborparametern Albumin, Ferritin und der Thrombozytenzahl mit dem Therapieergebnis einer Interferontherapie bei chronischer Hepatitis C besteht. Inwieweit hier mögliche Vorhersageparameter für einen Therapieerfolg vorliegen, sollte in prospektiven, randomisierten und doppelt-verblindeten Studien untersucht werden. Der Genotyp, das Eintrittsalter bei Therapiebeginn und der Grad der histologischen Leberveränderungen konnten als Prognosefaktoren für ein Therapieansprechen in Übereinstimmung mit der aktuellen Datenlage in der Literatur bestätigt werden. Auch der Einfluss des Geschlechts auf die Mortalität der Patienten mit einer chronischen Hepatitis C war signifikant. | |||||||
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| Lizenz: |  Urheberrechtsschutz | |||||||
| Fachbereich / Einrichtung: | Medizinische Fakultät | |||||||
| Dokument erstellt am: | 13.06.2012 | |||||||
| Dateien geändert am: | 13.06.2012 | |||||||
| Promotionsantrag am: | 28.10.2011 | |||||||
| Datum der Promotion: | 06.06.2012 |
