Iacobellis Angelo, Cozzolongo Raffaele, Minerva Nicola, Valvano Maria Rosa, Niro Grazia Anna, Fontana Rosanna, Palmieri Orazio, Ippolito Antonio, Andriulli Angelo
Division of Gastroenterology, Casa Sollievo della Sofferenza Hospital, IRCCS, San Giovanni Rotondo 71013, Italy.
Division of Gastroenterology, De Bellis Hospital, IRCCS, Castellana Grotte 70013, Italy.
Dig Liver Dis. 2014 Jul;46(7):621-4. doi: 10.1016/j.dld.2014.02.001. Epub 2014 Mar 25.
To investigate the feasibility of pegylated interferon plus ribavirin treatment in cirrhotic patients who presented with, or developed while on-treatment, platelet counts ≤ 80,000/μL and/or neutrophil counts ≤ 1,500/μL.
A retrospective analysis of prospectively gathered data on 123 cirrhotic patients treated with pegylated interferon and ribavirin. Adverse effects and haematological changes were monitored: bleeding and infectious events were registered and related to platelet and absolute neutrophil counts.
Among the 58 patients (47.2%) with nadir platelets ≤ 50,000/μL during therapy, 6 (10.3%) experienced a bleeding episode; of the remaining 65 patients with platelets constantly >50,000/μL, 3 (4.6%) bled. Of the 11 bleedings, 3 manifested during an infection, while patients had platelets >50,000/μL. Nadir neutrophils ≤ 750/μL occurred in 45 patients (38.2%) during treatment, and 14 of them (29.8%) had an infectious event. Infections were also documented in 18 of the 76 patients (23.7%) with neutrophils constantly >750/μL.
The study reveals the feasibility of treating cirrhotic patients with cytopenia with pegylated interferon and ribavirin, as bleeding or infectious events under therapy were unrelated to platelet and neutrophil counts. Withdrawal of therapy or variations in the pre-assigned dosages of either pegylated interferon or ribavirin owing to abnormally low haematological parameters seems to no longer be tenable.
探讨聚乙二醇化干扰素联合利巴韦林治疗血小板计数≤80,000/μL和/或中性粒细胞计数≤1,500/μL的肝硬化患者的可行性，这些患者在治疗时出现上述情况或治疗期间病情进展。
对123例接受聚乙二醇化干扰素和利巴韦林治疗的肝硬化患者的前瞻性收集数据进行回顾性分析。监测不良反应和血液学变化：记录出血和感染事件，并与血小板和绝对中性粒细胞计数相关联。
在治疗期间最低点血小板≤50,000/μL的58例患者（47.2%）中，6例（10.3%）发生出血事件；其余65例血小板持续>50,000/μL的患者中，3例（4.6%）出血。在11例出血事件中，3例在感染期间出现，而此时患者血小板>50,000/μL。45例患者（38.2%）在治疗期间最低点中性粒细胞≤750/μL，其中14例（29.8%）发生感染事件。在76例中性粒细胞持续>750/μL的患者中，18例（23.7%）也有感染记录。
该研究表明聚乙二醇化干扰素联合利巴韦林治疗血细胞减少的肝硬化患者是可行的，因为治疗期间的出血或感染事件与血小板和中性粒细胞计数无关。由于血液学参数异常低而停止治疗或改变聚乙二醇化干扰素或利巴韦林的预先设定剂量似乎不再合理。
