干扰素α-2b联合利巴韦林治疗慢性丙型肝炎对外周血细胞的影响

发布时间：2018-12-12 16:59

【摘要】：目的：总结干扰素联合利巴韦林治疗慢性丙型肝炎患者外周血细胞变化的发生发展规律，探讨影响外周血细胞改变的相关因素，阐明外周血细胞变化对SVR率的影响。方法：入选吉林大学第一医院肝胆胰内科2009年~2010年在吉林省扶余县更新乡和德胜镇进行的流行病学调查中发现的慢性丙型肝炎患者343例，给予药物INF-a2b500万U、隔日一次、皮下注射，利巴韦林15mg/kg.d口服，疗程48周；在基线、2周、12周、24周、36周、48周对患者进行血常规、HCV RNA定量等检测，治疗结束60周、72周、96周进行随访。出现中性粒细胞减少、贫血及血小板减少的患者依据《2010丙型肝炎防治指南》进行相应治疗或随访观察。结果： 1.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改变。抗病毒治疗过程中，外周血细胞减少多出现在治疗开始至12周内。 2.治疗2周内中性粒细胞、血红蛋白、血小板即有明显下降，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。 3.基线中性粒细胞绝对值、血小板计数、AST、ALT、肝纤维化程度与中性粒细胞减少症的发生及严重程度相关，具有统计学意义（p0.05）。性别与贫血的发生相关，基线血红蛋白水平与贫血的发生及严重程度均相关，，具有统计学意义（p0.05）。性别、基线中性粒细胞绝对值、血小板计数、AST、ALT、r-GT、肝纤维化程度与血小板减少症的发生相关，具有统计学意义（p0.05）。 4.2周血红蛋白降幅1.9g/dl、4周血小板计数降幅5×109/L的患者分别发生贫血、血小板减少症的几率更大（p0.05)。 5.中性粒细胞在任一监测点下降幅度与SVR率均不相关；血红蛋白4周降幅超过2.9g/dl、血小板4周下降幅度低于11.5×109/L的患者SVR率更高（p0.05)。结论： 1.抗病毒治疗2周内外周血细胞即有明显下降，12周时降至最低，提醒临床医生及时对患者进行随访及干预，避免严重不良事件的发生。 2.根据基线性别、外周血细胞水平、肝功、肝纤维化程度可评估抗病毒过程中外周血细胞减少是否发生及严重程度。 3.根据2周血红蛋白降幅、4周血小板降幅可提示整体治疗过程中贫血、血小板减少症发生几率。 4.4周血红蛋白、血小板降幅对SVR率具有一定预测作用。
[Abstract]:Objective: to summarize the changes of peripheral blood cells in patients with chronic hepatitis C treated with interferon and ribavirin, to explore the related factors affecting the changes of peripheral blood cells and to elucidate the effect of changes of peripheral blood cells on the rate of SVR. Methods: from 2009 to 2010, 343 patients with chronic hepatitis C were selected from Department of Hepatobiliary and Pancreatic Medicine of the first Hospital of Jilin University in Huexin Township and Desheng Town, Fuyu County, Jilin Province. The patients were given INF-a2b500 Wan U every other day. Ribavirin 15mg/kg.d was administered subcutaneously for 48 weeks. At baseline, 2 weeks, 12 weeks, 24 weeks, 36 weeks, 48 weeks, the patients were followed up at 60 weeks, 72 weeks and 96 weeks after treatment. Patients with neutropenia, anemia and thrombocytopenia were treated or followed up according to < 2010 guidelines for the prevention and treatment of hepatitis C. Results: 1. The incidence of neutropenia, anemia and thrombocytopenia were 40.5% (139 cases), 48.4% (166 cases) and 39.9% (137 cases). After treatment, some patients still had peripheral blood cell changes. In the course of anti-viral therapy, peripheral blood cell decline occurs within 12 weeks after treatment. 2. Neutrophils, hemoglobin and platelets decreased significantly within 2 weeks of treatment, and reached the lowest level at the 12th week, and increased slowly after 12 weeks, and recovered significantly at the end of the treatment (48 weeks) than at the 12th week. However, it did not reach the pre-treatment level, and at 60 ~ 72 weeks it tended to be stable and recovered to the pre-treatment level. 3. The baseline neutrophil absolute value, platelet count, and the degree of hepatic fibrosis in AST,ALT, were significantly correlated with the occurrence and severity of neutropenia (p0.05). Gender was associated with anemia, and baseline hemoglobin level was correlated with the incidence and severity of anemia (p0.05). Sex, baseline neutrophil absolute value, platelet count, and degree of hepatic fibrosis in AST,ALT,r-GT, were correlated with the occurrence of thrombocytopenia (p0.05). Patients with 4.2 weeks hemoglobin decreased by 1.9 g / dlg / L and platelet count decreased by 5 脳 10 ~ 9 / L at 4 weeks were more likely to develop anemia and thrombocytopenia (p0.05). 5. The decrease of neutrophils at any monitoring point was not related to the SVR rate. The decrease of hemoglobin in 4 weeks was more than 2.9 g / dl, and the decrease of platelet in 4 weeks was lower than 11.5 脳 10 9 / L, the SVR rate was higher (p0.05). Conclusion: 1. The peripheral blood cells decreased significantly within 2 weeks of antiviral therapy and reached the lowest at 12 weeks. The clinicians were reminded to follow up and intervene in time to avoid the occurrence of serious adverse events. 2. According to baseline sex, peripheral blood cell level, liver function, and liver fibrosis degree, we can evaluate the occurrence and severity of peripheral blood cell reduction during antiviral process. 3. According to the reduction of hemoglobin at 2 weeks, the decrease of platelet at 4 weeks may indicate the incidence of anemia and thrombocytopenia during the whole treatment. At 4. 4 weeks, hemoglobin and platelet decrease could predict the SVR rate.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R512.63

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