Caroleo B, Gallelli L, Staltari O, De Sarro G, Guadagnino V
Infective Diseases, Department of Experimental and Clinical Medicine, School of Medicine, University of Catanzaro, Germaneto, Italy.
Intervirology. 2008;51(6):407-9. doi: 10.1159/000205266. Epub 2009 Mar 4.
We report elevated serum alanine aminotransferase (ALT) levels during pegylated interferon (PEG-IFN)-alpha-2a in a patient with chronic HCV without other clinical manifestations.
A 38-year-old man presented for HCV infection evaluation. Serum aspartate aminotransferase (AST) and ALT levels were 43 and 116 U/l, respectively; RT-PCR blood analysis revealed HCV-RNA infection. PEG-IFN-alpha-2b plus ribavirin treatment induced both a rapid virologic response and a normalization of transaminase plasma levels. During follow-up, an increase in transaminase and HCV-RNA values prompted us to start a new antiviral treatment with PEG-IFN-alpha-2a plus ribavirin. Four months later, after the follow-up, a new blood test documented both a HCV-RNA titer <50 U/ml and an increase in ALT and AST plasma levels. Immunostaining of the liver biopsy showed an accumulation of PEG-IFN-alpha-2a. PEG-IFN-alpha-2a elimination and the addition of recombinant IFN-alpha-2a induced normalization of the plasma transaminase levels in about 2 months.
We postulate PEG-IFN-alpha-2a treatment because both the molecular weight and the distribution volume of the PEG-IFN may accumulate in the liver resulting in an increase of plasma transaminase levels. In contrast, during PEG-IFN-alpha-2b treatment, we did not document any increase in plasma transaminase values probably because of the lower molecular weight of the PEG.
我们报告了一名慢性丙型肝炎病毒（HCV）患者在接受聚乙二醇化干扰素（PEG-IFN）-α-2a治疗期间血清丙氨酸氨基转移酶（ALT）水平升高，且无其他临床表现。
一名38岁男性因HCV感染评估前来就诊。血清天冬氨酸氨基转移酶（AST）和ALT水平分别为43和116 U/l；逆转录聚合酶链反应（RT-PCR）血液分析显示HCV-RNA感染。PEG-IFN-α-2b联合利巴韦林治疗诱导了快速病毒学应答以及转氨酶血浆水平正常化。在随访期间，转氨酶和HCV-RNA值升高促使我们开始使用PEG-IFN-α-2a联合利巴韦林进行新的抗病毒治疗。四个月后的随访中，一项新的血液检测显示HCV-RNA滴度<50 U/ml，同时ALT和AST血浆水平升高。肝脏活检的免疫染色显示有PEG-IFN-α-2a蓄积。停用PEG-IFN-α-2a并加用重组IFN-α-2a后，血浆转氨酶水平在约2个月内恢复正常。
我们推测PEG-IFN-α-2a治疗导致血浆转氨酶水平升高是因为PEG-IFN的分子量和分布容积可能在肝脏蓄积。相比之下，在PEG-IFN-α-2b治疗期间，我们未发现血浆转氨酶值有任何升高，可能是因为PEG的分子量较低。
