聚乙二醇干扰素和利巴韦林联合治疗镰状细胞贫血患者慢性丙型肝炎的安全性。
Safety of pegylated interferon and ribavirin therapy for chronic hepatitis C in patients with sickle cell anemia.
作者信息
Issa Hussain
机构信息
Hussain Issa, Division of Gastroenterology, Department of Internal Medicine, King Fahad Specialist Hospital, Dammam, Sayhat 7312-32437, Saudi Arabia.
出版信息
World J Hepatol. 2010 May 27;2(5):180-4. doi: 10.4254/wjh.v2.i5.180.
AIM
To evaluate the safety and efficacy of combined pegylated interferon and ribavirin for the treatment of chronic hepatitis C (HCV) in patients with sickle cell anemia (SCA).
METHODS
Fifty-two patients with SCA and HCV were treated over a period of 7 years from June 2002 to July 2009. Their medical records were reviewed for: age at treatment, sex, body mass index, Hb level at the start of therapy and on follow-up, hemoglobin electrophoresis, liver function tests, G6PD level, LDH, bilirubin, HCV-RNA viral load, HCV genotype, liver biopsy, duration of treatment, and side effects. All were treated with pegylated interferon and a standard dose of ribavirin. The treatment was continued for 24 wk for those with genotype 2 and 3 and for 48 wk for those with genotype 1 and 4.
RESULTS
Fifty-two patients (30 females and 22 males) were treated. Their mean age was 29.5 years (range 15-54 years). HCV genotype was determined in 48 and 15 had liver biopsy. Their mean pre-treatment HCV-RNA viral load was 986330 IU/mL (range 12762-3329282 IU/mL). The liver biopsy showed grade I in 6 and grade II in 9 and stage I in 13 and stage II in 2. Only 8 were receiving hydroxyurea at the time of treatment. All tolerated the treatment well and none experienced a decrease in their Hb which required blood transfusion pre, during or after therapy. There were no hematological side effects attributable to ribavirin at the usual recommended dose. Thirty-seven (71.2%) achieved SVR at 6 mo after the end of treatment. The remaining 15 were non-responders. Two of them showed an ETR but had a relapse. The remaining 13 had a relatively significant HCV-RNA viral load with a mean HCV-RNA viral load of 1829741.2 IU/mL (900000-3329282 IU/mL) and eight of them had HCV genotype 1, four had HCV genotype 4, and one had HCV genotype 5.
CONCLUSION
Patients with SCA and HCV can be treated with pegylated interferon and ribavirin at the usual recommended dose. This is even so in those who are not receiving hydroxyurea. The treatment is safe and effective and the response rate is comparable to those without SCA.
目的
评估聚乙二醇化干扰素联合利巴韦林治疗镰状细胞贫血（SCA）合并慢性丙型肝炎（HCV）患者的安全性和疗效。
方法
2002年6月至2009年7月期间，对52例SCA合并HCV患者进行了为期7年的治疗。回顾他们的病历以了解：治疗时的年龄、性别、体重指数、治疗开始时及随访时的血红蛋白水平、血红蛋白电泳、肝功能检查、葡萄糖-6-磷酸脱氢酶（G6PD）水平、乳酸脱氢酶（LDH）、胆红素、HCV-RNA病毒载量、HCV基因型、肝活检、治疗持续时间及副作用。所有患者均接受聚乙二醇化干扰素和标准剂量的利巴韦林治疗。基因型2和3的患者治疗持续24周，基因型1和4的患者治疗持续48周。
结果
共治疗52例患者（30例女性和22例男性）。他们的平均年龄为29.5岁（范围15 - 54岁）。48例患者确定了HCV基因型，15例进行了肝活检。他们治疗前HCV-RNA病毒载量的平均值为986330 IU/mL（范围12762 - 3329282 IU/mL）。肝活检显示6例为I级，9例为II级，13例为I期，2例为II期。治疗时只有8例正在接受羟基脲治疗。所有患者对治疗耐受性良好，治疗前、治疗期间及治疗后均无血红蛋白下降需要输血的情况。在通常推荐剂量下，未出现可归因于利巴韦林的血液学副作用。37例（71.2%）在治疗结束后6个月达到持续病毒学应答（SVR）。其余15例为无应答者。其中2例显示早期病毒学应答（ETR）但复发。其余13例HCV-RNA病毒载量相对较高，平均HCV-RNA病毒载量为1829741.2 IU/mL（900000 - 3329282 IU/mL），其中8例为HCV基因型1，4例为HCV基因型4，1例为HCV基因型5。
结论
SCA合并HCV患者可以使用通常推荐剂量的聚乙二醇化干扰素和利巴韦林进行治疗。未接受羟基脲治疗的患者亦是如此。该治疗安全有效，应答率与无SCA的患者相当。
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