Fondazione G.B. Bietti, IRCCS, Roma, Italy.
Hepatology. 2012 Aug;56(2):455-63. doi: 10.1002/hep.25654. Epub 2012 Jun 11.
Treatment with pegylated interferon alpha (PegIFNα) and ribavirin is still regarded as the standard of care for chronic hepatitis C virus (HCV). Retinopathy has been occasionally described but prospective, longitudinal data are lacking. We investigated the frequency and clinical significance of retinopathy during therapy with PegIFNα and ribavirin in 97 consecutive HCV patients. In all, 54 (55.7%) and 43 (44.3%) patients were treated with PegIFNα 2a and PegIFNα 2b, respectively. Ophthalmologic examination was performed before therapy (baseline), at 3 and 6 months (3T and 6T, respectively) of therapy, and 3 months after the end of therapy (3ET). All patients underwent the baseline and 3T examination, 95.9% and 90.7% of patients underwent 6T and 3ET examination, respectively. Overall, 30.9% of patients developed retinopathy, as defined by the presence of cotton wool spots and/or retinal hemorrhages. Variables significantly associated with retinopathy during treatment were age (P = 0.004), metabolic syndrome (P = 0.05), hypertension (P < 0.0001), cryoglobulinemia (P = 0.05), and preexisting intraocular lesions at baseline (P = 0.01). By multivariate analysis, the only variable independently associated with PegIFNα-associated retinopathy was hypertension (hazard ratio [HR] = 4.99, 95% confidence interval [CI] 2.29-10.89). The frequency of retinopathy was significantly higher in hypertensive patients versus those without hypertension at all timepoints (18.5% versus 5.7% at baseline, P = 0.05; 48.1% versus 15.7% at 3T, P = 0.0009; 68.0% versus 19.1% at 6T, P < 0.0001; 32.0% versus 6.2%, P = 0.0005 at 3ET). In one (1.1%) hypertensive patient, who developed bilateral branch retinal vein occlusion at 6T, the therapy was discontinued. A cost analysis showed that screening for PegIFNα-associated retinopathy was cost-effective as compared with thyroid-stimulating hormone screening.
Retinopathy is frequent during treatment with PegIFNα and ribavirin, especially in hypertensive patients, who may develop serious complications. Screening for PegIFNα-associated retinopathy should be recommended for HCV patients with hypertension.
评估聚乙二醇干扰素 α（PegIFNα）联合利巴韦林治疗慢性丙型肝炎病毒（HCV）感染时发生视网膜病变的频率和临床意义。
前瞻性、观察性研究。
意大利的一家三级教学医院。
97 例连续的 HCV 患者。
在基线时、治疗 3 个月（3T）和 6 个月（6T）以及治疗结束后 3 个月（3ET）时进行眼科检查。
视网膜病变的发生率，定义为棉绒斑和/或视网膜出血的存在。
97 例患者中，30.9%的患者出现视网膜病变。治疗期间发生视网膜病变的相关因素有年龄（P = 0.004）、代谢综合征（P = 0.05）、高血压（P < 0.0001）、冷球蛋白血症（P = 0.05）和基线时存在眼内病变（P = 0.01）。多变量分析显示，高血压是与 PegIFNα 相关的视网膜病变的唯一独立相关因素（危险比[HR] = 4.99，95%置信区间[CI]为 2.29~10.89）。在所有时间点，高血压患者的视网膜病变发生率均显著高于无高血压患者（基线时为 18.5%比 5.7%，P = 0.05；3T 时为 48.1%比 15.7%，P = 0.0009；6T 时为 68.0%比 19.1%，P < 0.0001；3ET 时为 32.0%比 6.2%，P = 0.0005）。1 例（1.1%）高血压患者在 6T 时发生双侧视网膜分支静脉阻塞，停止了治疗。成本分析显示，与甲状腺刺激激素筛查相比，PegIFNα 相关视网膜病变的筛查具有成本效益。
PegIFNα 联合利巴韦林治疗 HCV 时，视网膜病变较为常见，尤其是高血压患者，可能会发生严重的并发症。建议对伴有高血压的 HCV 患者进行 PegIFNα 相关视网膜病变的筛查。
