Russo Mark W, Goldsweig Craig D, Jacobson Ira M, Brown Robert S
Division of Digestive Diseases and Nutrition, University of North Carolina, Chapel Hill, North Carolina 27599, USA.
Am J Gastroenterol. 2003 Jul;98(7):1610-5. doi: 10.1111/j.1572-0241.2003.07526.x.
Hepatitis C virus (HCV) is prevalent in patients with end stage renal disease who are on dialysis. Liver disease from HCV is a cause of substantial morbidity and mortality after kidney transplantation in infected recipients. Effective treatment of chronic HCV is needed in this group of patients. We aimed to determine from the literature the efficacy and safety of interferon monotherapy in dialysis patients with chronic HCV.
We reviewed the literature from 1986 to 2001 on the efficacy of interferon monotherapy in patients with HCV and end stage renal disease who were on dialysis. The outcomes measured were sustained viral response (SVR) and drop-out rate.
We reviewed 17 studies, of which 11 studies with a total of 213 patients met criteria for our analysis. Eight studies evaluated 3 million units (MU) three times/wk (t.i.w.), and three studies evaluated higher doses. The pooled SVR for 3 MU was 33% (95% CI = 21-51%). The pooled SVR for genotype 1 patients was 26% (95% CI = 15-37%). Of 152 patients in eight studies treated with 3 MU t.i.w. of interferon monotherapy, 45 patients (29.6%) discontinued therapy because of side effects.
Our analysis suggests that interferon monotherapy is more effective in patients on dialysis than in patients with normal renal function. Interferon monotherapy is associated with more adverse events in dialysis patients. The optimal dose and duration of interferon monotherapy and selection criteria of dialysis patients need to be studied further in clinical trials.
丙型肝炎病毒（HCV）在接受透析的终末期肾病患者中普遍存在。HCV所致的肝脏疾病是感染受体肾移植后发病和死亡的重要原因。这组患者需要有效治疗慢性HCV。我们旨在从文献中确定干扰素单一疗法在慢性HCV透析患者中的疗效和安全性。
我们回顾了1986年至2001年关于干扰素单一疗法在HCV和接受透析的终末期肾病患者中的疗效的文献。测量的结果是持续病毒学应答（SVR）和退出率。
我们回顾了17项研究，其中11项研究共213例患者符合我们的分析标准。8项研究评估了300万单位（MU），每周3次（tiw），3项研究评估了更高剂量。3MU的合并SVR为33%（95%CI=21-51%）。1型基因型患者的合并SVR为26%（95%CI=15-37%）。在8项使用3MU tiw干扰素单一疗法治疗的研究中的152例患者中，45例患者（29.6%）因副作用而停药治疗）。
我们的分析表明，干扰素单一疗法在透析患者中比在肾功能正常的患者中更有效。干扰素单一疗法在透析患者中与更多不良事件相关。干扰素单一疗法的最佳剂量和疗程以及透析患者的选择标准需要在临床试验中进一步研究。
