Kostić Velimir, Dordević Marina, Popović Lidija, Kostić Emina, Dordević Jovana, Govedarević Nenad
Klinika za infektivne bolesti, Klinicki centar Nis.
Med Pregl. 2009 Mar-Apr;62(3-4):129-32. doi: 10.2298/mpns0904129k.
HCV infection was common cause of morbidity and mortality in patients with hemophilia before 1986. We wanted to investigate the effect of treatment with combination therapy in HCV positive patients with hemophilia.
The research included totally 13 persons afflicted with hemophilia and HCV infection out of 21 tested. The patients were submitted to laboratory and clinical tests as well as genotypization, whereby a different hepatitis C virus genetic adherence was observed. Parallel with this subcategory the other one was put into comparison, consisting of 12 patients afflicted with chronic C hepatitis, marked as non-hemophilics. The both subcategories were treated with combination antiviral therapy (peginterferon alpha-2a and ribavirin) during 48 weeks for genotype 1 and 4, in reference to 24 weeks for genotype 2 and 3. Within the treatment, clinical and laboratory side-effects were noticed, which did not require therapy interruption. A more frequent hemorrhage during the therapy was found within the hemophilics, rather than before initiliazing it.
After the statistical processing of the results (Students' t-test), statistically significant difference among these two subcategories was noticed as values for ALT (***p<0.0001) after 24 weeks of therapy, red blood cells (*p<0.05), haemoglobin and haematocrite (***p<0.0001) 24 weeks after therapy completing By PCR examination of the patients, 6 months after the end of treatment, a sustained viral response (SVR) of the same percentage was registrated within both subcategories, which is even greater than what the other authors have described.
Main results were without important difference between two subgroups, except for higher number of spontanuous bleeding in group with hemophilia, which was somewhat expected. Most importantly, we didn't find any difference in SVR rates between groups.
HCV positive patients with hemophilia could be successfully treated with combination therapy of peginterferon alfa-2a and ribavirin.
1986年前，丙型肝炎病毒（HCV）感染是血友病患者发病和死亡的常见原因。我们想研究联合治疗对HCV阳性血友病患者的疗效。
在21名接受检测的患者中，共有13名患有血友病和HCV感染。患者接受了实验室检查、临床检查以及基因分型，观察到不同的丙型肝炎病毒基因黏附情况。与这一亚组平行的是另一组进行比较的患者，包括12名患有慢性丙型肝炎的患者，标记为非血友病患者。两个亚组均采用抗病毒联合治疗（聚乙二醇化干扰素α-2a和利巴韦林），1型和4型治疗48周，2型和3型治疗24周。在治疗过程中，观察到临床和实验室副作用，但无需中断治疗。与治疗前相比，血友病患者在治疗期间出血更为频繁。
对结果进行统计学处理（学生t检验）后，发现两个亚组之间存在统计学显著差异，治疗24周后的丙氨酸氨基转移酶（ALT）值（***p<0.0001）、治疗结束24周后的红细胞（*p<0.05）、血红蛋白和血细胞比容（***p<0.0001）。通过对患者治疗结束6个月后的PCR检测，两个亚组的持续病毒学应答（SVR）率相同，甚至高于其他作者所描述的情况。
除血友病组自发性出血较多外，两个亚组的主要结果无显著差异，这在一定程度上是预期的。最重要的是，我们发现两组之间的SVR率没有差异。
HCV阳性血友病患者可通过聚乙二醇化干扰素α-2a和利巴韦林联合治疗成功治愈。
