Toyoda H, Kumada T, Kiriyama S, Sone Y, Tanikawa M, Hisanaga Y, Kanamori A, Atsumi H, Nakano S, Arakawa T, Honda T, Hayashi K, Katano Y, Goto H
Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Gifu, Japan.
J Viral Hepat. 2008 Sep;15(9):651-8. doi: 10.1111/j.1365-2893.2008.01004.x. Epub 2008 Jul 10.
Serum ribavirin concentration is an important factor in antiviral therapy in combination with peginterferon (PEG-IFN) and ribavirin for patients with chronic hepatitis C in terms of both beneficial and adverse effects. We evaluated whether the serum ribavirin concentration can be predicted on the basis of renal function estimates. Serum creatinine and cystatin C concentrations were measured at the start of treatment in a total of 148 patients with chronic hepatitis C who underwent combination PEG-IFN and ribavirin therapy. Creatinine clearance (CrCl) and total clearance of ribavirin (CL/F) were calculated on the basis of the serum creatinine level. The glomerular filtration rate was calculated with two different formulae on the basis of the serum cystatin C level. These values were compared with serum ribavirin concentrations 4 weeks after the start of therapy. The cystatin C level increased with the progression of liver fibrosis, whereas the creatinine level was constant regardless of the degree of liver fibrosis. Significant correlation was not observed between the serum ribavirin concentration and serum creatinine level, cystatin C level, or calculated renal function estimates. However, significant correlation was found between the serum ribavirin concentration and CrCl and CL/F in patients who were given ribavirin >800 mg/day. Overall, renal function estimates do not correlate with the serum ribavirin concentration in Japanese patients with chronic hepatitis C who undergo combination PEG-IFN and ribavirin therapy. Serum creatinine-based renal function estimates might be predictive for the serum ribavirin concentration only in patients with a daily ribavirin intake of 800 mg or more.
对于慢性丙型肝炎患者，在聚乙二醇干扰素（PEG - IFN）联合利巴韦林的抗病毒治疗中，血清利巴韦林浓度无论是在有益作用还是不良反应方面都是一个重要因素。我们评估了是否可以根据肾功能评估来预测血清利巴韦林浓度。在总共148例接受PEG - IFN联合利巴韦林治疗的慢性丙型肝炎患者治疗开始时，测量了血清肌酐和胱抑素C浓度。根据血清肌酐水平计算肌酐清除率（CrCl）和利巴韦林的总清除率（CL/F）。基于血清胱抑素C水平，用两种不同公式计算肾小球滤过率。将这些值与治疗开始4周后的血清利巴韦林浓度进行比较。胱抑素C水平随肝纤维化进展而升高，而肌酐水平无论肝纤维化程度如何均保持恒定。在血清利巴韦林浓度与血清肌酐水平、胱抑素C水平或计算得出的肾功能评估之间未观察到显著相关性。然而，在每日给予利巴韦林>800 mg的患者中，发现血清利巴韦林浓度与CrCl和CL/F之间存在显著相关性。总体而言，对于接受PEG - IFN联合利巴韦林治疗的日本慢性丙型肝炎患者，肾功能评估与血清利巴韦林浓度不相关。基于血清肌酐的肾功能评估可能仅对每日利巴韦林摄入量为800 mg或更多的患者的血清利巴韦林浓度具有预测性。
