Prince Salman Center for Kidney Disease, Riyadh, Kingdom of Saudi Arabia.
Int Urol Nephrol. 2011 Sep;43(3):865-73. doi: 10.1007/s11255-010-9756-1. Epub 2010 May 19.
Chronic hepatitis C infection is common among patients on dialysis. While the associated liver disease is usually relatively mild during dialysis, disease progression can accelerate due to immunosuppression following kidney transplantation, and interferon therapy after transplantation stimulates graft rejection. Pegylated interferon and ribavirin are now the recommended treatment for chronic hepatitis C virus in patients without renal failure. However, until now, there has been relatively little information on the efficacy and tolerability of pegylated interferon in dialysis patients.
To evaluate the response to pegylated interferon alpha-2a in chronic hepatitis C-infected patients on chronic hemodialysis.
This controlled study included 28 patients with end-stage renal disease who had been on dialysis in the Prince Salman Center for Kidney Disease for more than 6 months and tested positive for HCV RNA on repeated occasions. Thirteen patients were treated with pegylated interferon alpha-2a therapy (of which three were also receiving ribavirin), and the remaining fifteen served as controls. Viral genotyping and both qualitative and quantitative PCR were carried out before starting therapy. Treatment was continued for 48 weeks. After 24 weeks of treatment, the biochemical and virological responses were evaluated. Biochemical response was evaluated at the end of the treatment, with sustained virological response (SVR) being evaluated 24 weeks later. The side effects were monitored throughout the treatment period.
All patients in the treatment group completed 48 weeks of therapy without any drop out. Their mean age was 43.38 ± 11.62 years. After 24 weeks of therapy, 10 patients (76%) were initial responders, while 3 patients (24%) were resistant. Six months after termination of therapy, 9 patients (69%) were sustained responders, while one patient relapsed. Their ALT and AST dropped from 55.78 ± 33.79 IU/dl and 34.04 ± 19.58 IU/dl before starting therapy to 27.22 ± 16.54 IU/dl and 18.88 ± 12.28 IU/dl after termination (P = .06 and .08, respectively). Their mean hemoglobin (Hb) level dropped from 11.05 ± 1.43 to 9.48 ± 1.24 g/dl (P = 0.3), and white blood cell count (WBC) dropped from 6.82 ± 2.6 × 10(3)/mm(3) to 4.1 ± 2.34 × 10(3)/mm(3); (P = 0.57). Platelet count fell from 194.56 ± 129.78 × 10(3)/mm(3) to (152.33 ± 107.66 × 10(3)/mm(3); P = 0.39). When initial responders (n = 10) were compared to resistant patients (n = 3), the only observable difference was higher ALT and AST levels in resistant patients. Pegylated interferon alpha-2a was well tolerated, and none of the patients stopped interferon because of hematological side effects while dose modification was carried out in most of the patients. All three patients who received combination therapy from the start were sustained responders. None of the patients in the control group seroconverted to HCV negative status during the study period.
Pegylated interferon alpha-2a was well tolerated among our hemodialysis patients. Hematological disturbances appeared to be the most important adverse effects. At the end of therapy a response rate of up to 76%, with 69% sustained response, can be obtained with pegylated interferon alpha-2a therapy.
慢性丙型肝炎感染在透析患者中很常见。虽然在透析期间相关的肝脏疾病通常相对较轻，但在肾移植后免疫抑制以及移植后干扰素治疗刺激移植物排斥后，疾病进展可能会加速。聚乙二醇干扰素和利巴韦林现在是肾功能衰竭患者慢性丙型肝炎病毒的推荐治疗方法。然而，到目前为止，关于聚乙二醇干扰素在透析患者中的疗效和耐受性的信息相对较少。
评估聚乙二醇干扰素α-2a 在慢性丙型肝炎感染的慢性血液透析患者中的反应。
这项对照研究包括 28 名在王子 Salman 肾脏病中心接受透析治疗超过 6 个月且多次检测 HCV RNA 阳性的终末期肾病患者。13 名患者接受聚乙二醇干扰素α-2a 治疗（其中 3 名同时接受利巴韦林治疗），其余 15 名作为对照组。在开始治疗前进行病毒基因分型和定性及定量 PCR。治疗持续 48 周。治疗 24 周后评估生化和病毒学反应。治疗结束时评估生化反应，24 周后评估持续病毒学反应（SVR）。整个治疗期间监测副作用。
治疗组的所有患者均完成了 48 周的治疗，无任何脱落。他们的平均年龄为 43.38 ± 11.62 岁。治疗 24 周后，10 名患者（76%）为初始应答者，3 名患者（24%）为耐药者。治疗结束后 6 个月，9 名患者（69%）为持续应答者，1 名患者复发。他们的 ALT 和 AST 从治疗前的 55.78 ± 33.79 IU/dl 和 34.04 ± 19.58 IU/dl 降至治疗结束时的 27.22 ± 16.54 IU/dl 和 18.88 ± 12.28 IU/dl（P =.06 和.08）。他们的平均血红蛋白（Hb）水平从 11.05 ± 1.43 降至 9.48 ± 1.24 g/dl（P = 0.3），白细胞计数（WBC）从 6.82 ± 2.6×10(3)/mm(3)降至 4.1 ± 2.34×10(3)/mm(3)（P = 0.57）。血小板计数从 194.56 ± 129.78×10(3)/mm(3)降至（152.33 ± 107.66×10(3)/mm(3)；P = 0.39）。将初始应答者（n = 10）与耐药患者（n = 3）进行比较，唯一可观察到的差异是耐药患者的 ALT 和 AST 水平较高。聚乙二醇干扰素α-2a 耐受性良好，没有患者因血液学副作用而停止干扰素治疗，而大多数患者都进行了剂量调整。从一开始就接受联合治疗的 3 名患者均为持续应答者。在研究期间，对照组中没有患者血清 HCV 转为阴性。
聚乙二醇干扰素α-2a 在我们的血液透析患者中耐受性良好。血液学紊乱似乎是最重要的不良反应。治疗结束时，聚乙二醇干扰素α-2a 治疗可获得高达 76%的应答率，持续应答率为 69%。
