干扰素α-2b联合利巴韦林治疗后慢性丙型肝炎患者外周血细胞数量的变化及其临床意义

发布时间：2018-03-17 12:04

本文选题：干扰素α-b　切入点：利巴韦林　出处：《吉林大学学报(医学版)》2015年03期 　论文类型：期刊论文

【摘要】：目的:探讨干扰素α-2b(INF-α2b)联合利巴韦林治疗后慢性丙型肝炎患者外周血细胞数量的变化,阐明影响外周血细胞数量的相关因素。方法:选择343例慢性丙型肝炎患者(有慢性肝炎的症状且抗-HCV和HCV-RNA阳性),均给予药物INF-α2b500万U、隔日1次、皮下注射,利巴韦林15mg·kg-1·d-1口服,疗程48周;在基线、2周、12周、24周、36周和48周对患者进行血常规、HCV RNA定量等检测,治疗后60、72和96周进行随访。出现中性粒细胞绝对值数减少、贫血及血小板计数减少的患者依据《2010丙型肝炎防治指南》进行相应治疗或随访观察。结果:治疗过程中中性粒细胞减少症发病率为40.5%(139例),贫血发病率为48.4%(166例),血小板减少症发病率为39.9%(137例)。治疗结束后仍有个别患者出现外周血细胞数量改变。抗病毒治疗过程中,外周血细胞数量减少多出现在治疗开始至12周内。治疗2周内中性粒细胞、血红蛋白和血小板计数即有明显下降,至第12周时同时降到最低值,12周后出现缓慢上升,治疗结束时(48周)虽较12周恢复明显,但仍未达到治疗前水平,60~72周时趋于平稳且恢复到治疗前水平。基线中性粒细胞绝对值、血小板计数、天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、肝纤维化程度与中性粒细胞减少症的发生及严重程度有关联(P0.05)。性别与贫血的发生有关联,基线血红蛋白水平与贫血的发生及严重程度均有关联(P0.05)。性别、基线中性粒细胞绝对值、血小板计数、AST、ALT、γ-谷氨酰转肽酶(γ-GT)、肝纤维化程度与血小板减少症的发生有关联(P0.05)。结论:抗病毒治疗2周内慢性丙型肝炎患者外周血细胞数量即有明显下降,12周时降至最低,临床医生应及时对患者进行随访及干预,避免严重不良事件的发生。根据基线性别、外周血细胞水平、肝功能和肝纤维化程度可评估抗病毒过程中患者外周细胞数量是否减少及严重程度。
[Abstract]:Objective: to investigate the changes of peripheral blood cell count in patients with chronic hepatitis C after treatment with interferon 伪 -2btin-INF- 伪 2b) and ribavirin. Methods: three hundred and thirty three patients with chronic hepatitis C (who had symptoms of chronic hepatitis and were anti-HCV and HCV-RNA positive) were given the drug INF- 伪 2 b 5 million U, once every other day, subcutaneously, and ribavirin 15 mg 路kg-1 路d -1 orally. The course of treatment was 48 weeks, and the blood routine RNA quantitative analysis was performed at baseline 2 weeks, 12 weeks, 24 weeks, 36 weeks and 48 weeks. The patients were followed up at 60,72 and 96 weeks after treatment. The absolute number of neutrophils decreased. Patients with anemia and thrombocytopenia were treated or followed up according to the guidelines for the Prevention and treatment of Hepatitis C 2010. Results: during the course of treatment, the incidence of neutropenia was 40.5%, the incidence of anemia was 48.4%, and the incidence of anemia was 48.4%. The incidence of small plate reduction is 39. 9% and 137 cases. After the treatment, some patients still have the change of peripheral blood cell number. The number of peripheral blood cells decreased from the beginning of treatment to 12 weeks after treatment. In the second week of treatment, the hemoglobin and platelet count decreased significantly, and at the 12th week, the number of peripheral blood cells decreased to the lowest value at the same time and increased slowly after 12 weeks of treatment. The baseline neutrophil absolute value, platelet count, baseline neutrophil absolute value, platelet count, the baseline neutrophil absolute value, the platelet count, the baseline neutrophil absolute value, the platelet count, the baseline neutrophil absolute value, the platelet count, the baseline neutrophil absolute value, the platelet count, Aspartate aminotransferase (AST) and alanine aminotransferase (alt) were found to be associated with the occurrence and severity of neutropenia. The baseline hemoglobin level was associated with the occurrence and severity of anemia (P0.055.Sex, absolute value of baseline neutrophils), Platelet count, alt, 纬 -GT, liver fibrosis was associated with the occurrence of thrombocytopenia. Conclusion: the number of peripheral blood cells in patients with chronic hepatitis C decreased significantly within 2 weeks of antiviral therapy, and decreased to the lowest at 12 weeks. Clinicians should follow up and intervene in time to avoid serious adverse events. Liver function and liver fibrosis can be used to evaluate whether the number and severity of peripheral cells in patients with antiviral diseases are reduced.
【作者单位】：吉林大学第一医院肝胆胰内科;吉林大学第一医院感染症科;
【基金】：国家自然科学基金资助课题(81072347)
【分类号】：R512.63

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