Lashin A H, Shaheen Y A, Metwally M A, El-Feky H M, Hegab M F, Abbas S M
Hepatology, Gastroenterology, and Infectious Diseases Department, Benha University, Benha, PO Box 31518, Qualubia, Egypt.
Indian J Gastroenterol. 2013 Sep;32(5):316-23. doi: 10.1007/s12664-013-0336-z. Epub 2013 May 29.
The aim of this paper was to study the incidence and predictors of hematological abnormalities during treatment of chronic hepatitis C virus (HCV) patients with interferon and ribavirin.
One thousand and eighty-one chronic HCV patients who were treated with PEGylated interferon α-2a 180 μg (n = 536) or α-2b 1.5 μg/kg (n = 545) plus ribavirin for 48 weeks were included. Baseline demographic, laboratory, and histopathological data and, during treatment, hematological data were collected and analyzed using univariate and multivariate analyses to identify independent predictors of hematological side effects.
During therapy, 168 of 1,018 (15.5 %) had moderate anemia (Hb <10 and ≥8.5 g/dL) and 88 (8.1 %) had severe anemia (Hb <8.5 g/dL). Two hundred and six patients (19.1 %) had moderate neutropenia (absolute neutrophil count (ANC) <750 and ≥500/mm(3)); only 55 (5.1 %) had severe neutropenia (ANC <500/mm(3)). Forty-three patients (4 %) had moderate (platelet <50,000 and ≥25,000/mm(3)) and 5 (1.4 %) had severe thrombocytopenia (platelet <25,000/mm(3)). Fibrosis stage, week 4 Hb level, and week 2 and 4 reduction level in Hb were independent predictors of moderate and severe anemia (p < 0.001). Fibrosis stage and ANC at weeks 2 and 4 were predictors of neutropenia (p < 0.001, 0.001, and 0.004, respectively). Fibrosis stage and platelet count at weeks 2 and 4 were predictors of thrombocytopenia (p < 0.001, <0.001, and 0.005, respectively). There was no association between interferon type and anemia (p = 0.57), neutropenia (p = 0.6), or thrombocytopenia (p = 0.79).
Fibrosis stage and week 2 and 4 hematological parameter reduction levels were independent predictors of hematological side effects, which are not related to interferon type.
本文旨在研究慢性丙型肝炎病毒（HCV）患者接受干扰素和利巴韦林治疗期间血液学异常的发生率及预测因素。
纳入1081例接受聚乙二醇化干扰素α-2a 180μg（n = 536）或α-2b 1.5μg/kg（n = 545）联合利巴韦林治疗48周的慢性HCV患者。收集基线人口统计学、实验室和组织病理学数据，以及治疗期间的血液学数据，采用单因素和多因素分析来确定血液学副作用的独立预测因素。
治疗期间，1018例患者中有168例（15.5%）出现中度贫血（血红蛋白<10且≥8.5g/dL），88例（8.1%）出现重度贫血（血红蛋白<8.5g/dL）。206例患者（19.1%）出现中度中性粒细胞减少（绝对中性粒细胞计数（ANC）<750且≥500/mm³）；仅有55例（5.1%）出现重度中性粒细胞减少（ANC<500/mm³）。43例患者（4%）出现中度血小板减少（血小板<50,000且≥25,000/mm³），5例（1.4%）出现重度血小板减少（血小板<25,000/mm³）。纤维化分期、第4周血红蛋白水平以及第第2周和第4周血红蛋白降低水平是中度和重度贫血的独立预测因素（p<0.001）。纤维化分期以及第2周和第4周的ANC是中性粒细胞减少的预测因素（分别为p<0.001、0.001和0.004）。纤维化分期以及第2周和第4周的血小板计数是血小板减少的预测因素（分别为p<0.001、<0.001和0.005）。干扰素类型与贫血（p = 0.57）、中性粒细胞减少（p = 0.6）或血小板减少（p = 0.79）之间无关联。
纤维化分期以及第2周和第4周血液学参数降低水平是血液学副作用的独立预测因素，且与干扰素类型无关。
