Wang Huan, Innes Hamish, Hutchinson Sharon J, Goldberg David J, Allen Samuel, Barclay Stephen T, Bramley Peter, Fox Raymond, Fraser Andrew, Hayes Peter C, Kennedy Nicholas, Mills Peter R, Dillon John F
aDundee Epidemiology and Biostatistics Unit, University of Dundee bDivision of Cardiovascular and Diabetes Medicine, Medical Research Institute, Ninewells Hospital and Medical School, Dundee cSchool of Health and Life Sciences, Glasgow Caledonian University dHealth Protection Scotland eWalton Liver Clinic, Glasgow Royal Infirmary fGartnavel General Hospital, Glasgow gCrosshouse Hospital, Kilmarnock hDepartment of Hepatology, Stirling Community Hospital, Stirling iAberdeen Royal Infirmary, Aberdeen jRoyal Infirmary Edinburgh, Edinburgh kMonklands Hospital, Lanarkshire, UK.
Eur J Gastroenterol Hepatol. 2016 Apr;28(4):398-404. doi: 10.1097/MEG.0000000000000556.
The aim of the study was to explore the extent of thrombocytopenia (TCP), anaemia and leucopenia in patients with hepatitis C and evaluate how they impact the management of antiviral therapy, the attainment of sustained virological response (SVR), and some therapy-related adverse events.
The Scottish Hepatitis C Clinical Database was used in this retrospective study. The prevalence of TCP, anaemia and leucopenia was evaluated. The impact of the three deficiencies on antiviral therapy management, serious adverse events and SVR attainment was assessed in patients who received therapy.
The prevalence of TCP, anaemia and leucopenia was 18.5, 0.9 and 0.2% among 4907 treated patients at baseline, increasing to 72, 25.8 and 5.4% during treatment, respectively. Dose reduction occurred in 29.3% of the patients without TCP; this percentage was higher in those with baseline TCP (53%) and in those who acquired it during treatment (35%). Similar results were found for anaemia and leucopenia. Baseline TCP (odds ratio=0.67, P<0.001) and baseline anaemia (odds ratio=0.43, P=0.03) were identified as risk factors associated with lower SVR rate; acquired TCP and anaemia were not associated with reduced SVR.
Baseline TCP or anaemia increased the risk of dose cessation. Patients who acquired TCP, anaemia or leucopenia during treatment did not exhibit compromised SVR rates, whereas patients with TCP or anaemia at baseline did. The potential benefit of growth factors in maintaining SVR rate is likely to be confined to those with baseline TCP or anaemia rather than to those who acquire it during therapy, where dose reduction does not appear to reduce the chance of SVR.
本研究旨在探讨丙型肝炎患者血小板减少症（TCP）、贫血和白细胞减少症的程度，并评估它们如何影响抗病毒治疗的管理、持续病毒学应答（SVR）的实现以及一些与治疗相关的不良事件。
本回顾性研究使用了苏格兰丙型肝炎临床数据库。评估了TCP、贫血和白细胞减少症的患病率。在接受治疗的患者中，评估了这三种缺陷对抗病毒治疗管理、严重不良事件和SVR实现的影响。
在4907例接受治疗的患者中，基线时TCP、贫血和白细胞减少症的患病率分别为18.5%、0.9%和0.2%，治疗期间分别增至72%、25.8%和5.4%。无TCP的患者中有29.3%出现剂量减少；基线时有TCP的患者（53%）和治疗期间出现TCP的患者（35%）中这一比例更高。贫血和白细胞减少症也有类似结果。基线TCP（优势比=0.67，P<0.001）和基线贫血（优势比=0.43，P=0.03）被确定为与较低SVR率相关的危险因素；治疗期间出现的TCP和贫血与SVR降低无关。
基线TCP或贫血增加了停药风险。治疗期间出现TCP、贫血或白细胞减少症的患者SVR率未受影响，而基线时有TCP或贫血的患者则受影响。生长因子维持SVR率的潜在益处可能仅限于基线时有TCP或贫血的患者，而非治疗期间出现这些情况的患者，因为剂量减少似乎并未降低SVR的机会。
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