Department of Gastroenterology and Hepatology, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Hepatology. 2010 Oct;52(4):1225-31. doi: 10.1002/hep.23842.
Neutropenia during treatment with peginterferon alfa and ribavirin for chronic hepatitis C virus (HCV) infection is a common cause of dose reductions of peginterferon alfa. These reductions are performed to prevent bacterial and fungal infections, which are common during HCV treatment and can be attributed to neutropenia. The aims of this study were to investigate the occurrence of infections and their relation to neutropenia and to identify potential risk factors for infections during HCV treatment. In this single-center cohort study, 2,876 visits of 321 patients treated with peginterferon alfa and ribavirin were evaluated for neutropenia, infections, dose reductions, and potential risk factors for infection during HCV treatment. The baseline mean absolute neutrophil count (ANC) was 3,420 cells/μL, and 16 patients had a baseline ANC of <1,500 cells/μL. During treatment, neutropenia, which was defined as ANC <750 cells/μL, was observed in 95 patients (29.7%) and ANC <375/μL was observed in 16 patients (5%). Ninety-six infections were observed in 70 patients (21.8%). Thirteen infections (13.5%) were defined as severe. Infections were not correlated with neutropenia during treatment. Dose reductions did not lead to a decrease in infection rate. Multivariate logistic regression analysis revealed that age >55 years (odds ratio [OR] 2.06, 95% confidence interval [CI] 1.19-3.56, P = 0.01) and baseline hyperglycemia (OR 2.17, 95% CI 1.15-4.10, P = 0.016) were associated with an increased risk of infection during HCV treatment. Cirrhosis and chronic obstructive pulmonary disease were not risk factors for infection.
Bacterial infections during treatment with peginterferon alfa and ribavirin are not associated with neutropenia. Older patients and patients with poorly controlled diabetes mellitus have a greater risk of developing infections during HCV treatment.
研究中性粒细胞减少症的发生及其与中性粒细胞减少症的关系，并确定丙型肝炎病毒（HCV）治疗期间感染的潜在危险因素。
在这项单中心队列研究中，对 321 例接受聚乙二醇干扰素 alfa 和利巴韦林治疗的患者的 2876 次就诊进行了中性粒细胞减少症、感染、剂量减少以及 HCV 治疗期间感染的潜在危险因素评估。
基线时的绝对中性粒细胞计数（ANC）平均值为 3420 个/μL，有 16 例患者的 ANC<1500 个/μL。在治疗期间，95 例（29.7%）患者出现中性粒细胞减少症，定义为 ANC<750 个/μL，16 例（5%）患者出现 ANC<375/μL。70 例患者（21.8%）发生了 96 例感染。其中 13 例（13.5%）感染被定义为严重感染。感染与治疗期间的中性粒细胞减少症无关。剂量减少并未导致感染率降低。多变量逻辑回归分析显示，年龄>55 岁（比值比[OR] 2.06，95%置信区间[CI] 1.19-3.56，P=0.01）和基线高血糖（OR 2.17，95%CI 1.15-4.10，P=0.016）与 HCV 治疗期间感染风险增加相关。肝硬化和慢性阻塞性肺疾病不是感染的危险因素。
聚乙二醇干扰素 alfa 和利巴韦林治疗期间发生的细菌感染与中性粒细胞减少症无关。年龄较大的患者和糖尿病控制不佳的患者在 HCV 治疗期间发生感染的风险更高。
