Hofer Harald, Gurguta Calin, Bergholz Ulrike, Steindl-Munda Petra, Ferenci Peter
Department of Internal Medicine IV, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria.
Wien Klin Wochenschr. 2006 Oct;118(19-20):595-600. doi: 10.1007/s00508-006-0704-0.
Patients with advanced liver disease due to thrombocytopenia and chronic infection with hepatitis C virus (HCV) are difficult to treat in view of concerns about the efficacy and safety of interferon-based therapy. Nevertheless, antiviral therapy might have a substantial benefit in these patients as it potentially minimizes disease progression and prevents recurrence after liver transplantation. We evaluated the safety, efficacy and tolerability of standard interferon-alpha in an accelerating dose regimen in combination with ribavirin in patients with HCV-induced liver cirrhosis and thrombocytopenia.
Nine patients (M=8, age: 48.4 +/- 9.9, mean +/- SD) with HCV-related advanced liver disease and thrombocytopenia were prospectively investigated. The Child-Pugh stage was A in six patients and B in three, the MELD score was 11 [6-17] (median [range]). Four patients were interferon naive. HCV-genotype distribution was 1b (n=3), 3a (n=4) and 4 (n=2). The patients received 1-1.5 MU/d standard interferon-a2b with increasing dose regimen and weight-based ribavirin for 48 weeks (genotype 1), or 24 weeks (genotype 3), or until liver transplantation, respectively.
The baseline platelet count was 64.3 +/- 8.7 (G/l, mean +/- SD) and remained remarkably stable during treatment (58.0 +/- 12.4 G/l at week 4, 51.7 +/- 20.5 G/l at week 8, P=0.1). All patients had adverse events such as weight loss, fever and anorexia. Hospitalization because of decompensation or infection was necessary in three patients. Three patients underwent liver transplantation. A virological response on treatment was achieved in eight patients and sustained in three (33.3%) patients.
Treatment with standard interferon-alpha2b/ribavirin could be of benefit in patients with advanced liver cirrhosis and thrombocytopenia however, a vigilant monitoring of these high risk patients is mandatory.
鉴于对基于干扰素治疗的疗效和安全性的担忧，因血小板减少和丙型肝炎病毒（HCV）慢性感染导致晚期肝病的患者难以治疗。然而，抗病毒治疗可能对这些患者有实质性益处，因为它有可能将疾病进展降至最低，并防止肝移植后复发。我们评估了标准干扰素-α以加速剂量方案联合利巴韦林治疗HCV诱导的肝硬化和血小板减少患者的安全性、疗效和耐受性。
对9例（男性8例，年龄：48.4±9.9，均值±标准差）HCV相关晚期肝病和血小板减少患者进行了前瞻性研究。Child-Pugh分级6例为A期，3例为B期，终末期肝病模型（MELD）评分中位数为11[6 - 17]（范围）。4例患者既往未接受过干扰素治疗。HCV基因型分布为1b型（n = 3）、3a型（n = 4）和4型（n = 2）。患者分别接受1 - 1.5 MU/d标准干扰素-α2b，采用递增剂量方案和基于体重的利巴韦林治疗48周（1型基因型）、24周（3型基因型）或直至肝移植。
基线血小板计数为64.3±8.7（G/L，均值±标准差），治疗期间保持显著稳定（第4周时为58.0±12.4 G/L，第8周时为51.7±20.5 G/L，P = 0.1）。所有患者均有体重减轻、发热和厌食等不良事件。3例患者因失代偿或感染需要住院治疗。3例患者接受了肝移植。8例患者治疗后获得病毒学应答，3例（33.3%）患者持续应答。
标准干扰素-α2b/利巴韦林治疗可能对晚期肝硬化和血小板减少患者有益，然而，对这些高危患者进行密切监测是必要的。
