Arambarri M, Fernández Lucas M, Echarri R, Teruel J L, Alarcón C, Merino J L, Ortuño J
Servicio de Nefrología, Hospital Ramón y Cajal, Madrid.
Nefrologia. 2004;24 Suppl 3:39-42.
Traditionally, the treatment of viral hepatitis C (positive Polymerase Chain Reaction -PCR-) was with Interferon. A combination of Interferon plus Ribavirin has been producing better results in last years. Currently, Ribavirin is not indicated for patients with Chronic Kidney Disease because of a high risk of severe anaemia. In a few cases, this treatment is producing good results with previous dose adjustment. We show a case of a 28-year-old man with Chronic Kidney Disease on treatment with periodical hemodialysis and chronic hepatopathy HCV Positive RNA HCV (> 1,000,000 copies/ml) and persistent transaminase elevation. Before kidney transplantation, we decided to use Interferon (3,000,000 IU/48 hours) and Ribavirin (200 mg/24 hours) treatment. After 15 days, we saw normal transaminase values and HCV RNA was negative. The patient required temporary suspension of Ribavirin and two red blood cell transfusions due to severe anaemia. Ribavirin was reintroduced 200 mg/48 h posthemodialysis. The patient did not present any complication again, and could be treated for 14 months. After next 11 months of evolution the patient has normal rates of liver function and negative HCV RNA values.
传统上,丙型病毒性肝炎(聚合酶链反应-PCR-阳性)的治疗方法是使用干扰素。近年来,干扰素联合利巴韦林的治疗效果更佳。目前,由于严重贫血风险较高,利巴韦林不适用于慢性肾脏病患者。在少数情况下,通过调整先前的剂量,这种治疗取得了良好效果。我们报告了一例28岁男性患者,患有慢性肾脏病,需定期进行血液透析,同时患有慢性肝病,HCV RNA呈阳性(HCV>1,000,000拷贝/毫升)且转氨酶持续升高。在进行肾脏移植前,我们决定使用干扰素(3,000,000国际单位/48小时)和利巴韦林(200毫克/24小时)进行治疗。15天后,我们观察到转氨酶值恢复正常,HCV RNA呈阴性。由于严重贫血,患者需要暂时停用利巴韦林并接受两次红细胞输血。血液透析后200毫克/48小时重新使用利巴韦林。此后患者未再出现任何并发症,治疗持续了14个月。在接下来的11个月病情进展中,患者肝功能指标正常,HCV RNA值为阴性。