聚乙二醇干扰素和利巴韦林治疗的慢性丙型肝炎患者的抑郁发作发生率
DEPRESSIVE EPISODE INCIDENCE IN PATIENTS WITH CHRONIC HEPATITIS C TREATED WITH PEGYLATED INTERFERON AND RIBAVIRIN.
作者信息
Vabo Izabella Liguori Corsino, Ferreira Lincoln Eduardo Villela Vieira de Castro, Pace Fábio Heleno Lima
机构信息
Centro de Referência em Hepatologia, Hospital Universitário, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil; , Universidade Federal de Juiz de Fora, Centro de Referência em Hepatologia, Hospital Universitário, Universidade Federal de Juiz de Fora, Juiz de Fora MG , Brazil.
Departamento de Psicologia Hospitalar, Hospital e Maternidade Therezinha de Jesus, Juiz de Fora, MG, Brasil; , Departamento de Psicologia Hospitalar, Hospital e Maternidade Therezinha de Jesus, Juiz de Fora MG , Brasil.
出版信息
Arq Gastroenterol. 2016 Jan-Mar;53(1):20-4. doi: 10.1590/S0004-28032016000100005.
BACKGROUND
The effectiveness of antiviral therapy with pegylated interferon and ribavirin for chronic hepatitis C is far from ideal and presents several adverse events. Among such events, there is the depressive episode that can even lead to treatment discontinuity.
OBJECTIVE
Analyze the incidence of depressive episodes in patients with chronic hepatitis C treated with pegylated interferon (IFN-PEG) and ribavirin, as well as the possible factors associated with its occurrence and its impact on patients' sustained virological response.
METHODS
People with chronic hepatitis C undergoing antiviral therapy were interviewed at the baseline, at the 4th, 12th, 24th and 48th treatment weeks and 4 weeks after the end of it, using the HADS scale for tracking the depressive episode. Patients with HADS ≥9 were subjected to Beck Depression Inventory (BDI-II) to grade the episode. Clinical, sociodemographic, laboratorial and histological variables were obtained to identify factors related to the onset of depression. The sustained virological response rate (negative HCV-RNA 6 months after end of therapy) was compared among patients with and without depressive symptoms.
RESULTS
The study comprised 32 patients, most men (59%) with mean age of 54±11.13 years old. Genotype non-1 was prevalent (56%) and 81% of the patients were non-cirrhotic. The depressive episode was diagnosed in 25% of the patients and the peak incidence was found in the 12th treatment week. The depressive episode was moderate in 87% of the patients and only one patient abandoned the treatment. None of the analyzed factors was associated with depressive episode onset. A trend was observed in female patients ( P =0.08). The sustained virological response rate was of 75% and 67% in patients with and without depressive episode, respectively ( P =0.66).
CONCLUSION
The incidence of depressive episodes in patients with chronic hepatitis C undergoing antiviral therapy was of 25% and the 12th treatment week was the most critical one. The presence of depressive episode did not affect the sustained virological response rate.
背景
聚乙二醇干扰素和利巴韦林联合抗病毒治疗慢性丙型肝炎的效果远不理想，且存在多种不良事件。其中，抑郁发作甚至可能导致治疗中断。
目的
分析聚乙二醇干扰素（IFN-PEG）联合利巴韦林治疗慢性丙型肝炎患者抑郁发作的发生率、与其发生相关的可能因素及其对患者持续病毒学应答的影响。
方法
采用医院焦虑抑郁量表（HADS）对接受抗病毒治疗的慢性丙型肝炎患者在基线期、治疗第4周、第12周、第24周、第48周及治疗结束后4周进行访谈，以追踪抑郁发作情况。HADS评分≥9分的患者接受贝克抑郁量表（BDI-II）评估以对发作程度进行分级。获取临床、社会人口学、实验室及组织学变量以确定与抑郁发作相关的因素。比较有抑郁症状和无抑郁症状患者的持续病毒学应答率（治疗结束6个月后HCV-RNA阴性）。
结果
该研究纳入32例患者，多数为男性（59%），平均年龄54±11.13岁。非1型基因型占多数（56%），81%的患者无肝硬化。25%的患者被诊断为抑郁发作，发作高峰出现在治疗第12周。87%的患者抑郁发作程度为中度，仅有1例患者中断治疗。分析的所有因素均与抑郁发作无关。女性患者中观察到一种趋势（P =0.08）。有抑郁发作和无抑郁发作患者的持续病毒学应答率分别为７５％和６７％（P =0.66）。
结论
接受抗病毒治疗的慢性丙型肝炎患者抑郁发作的发生率为25%，治疗第12周最为关键。抑郁发作的存在不影响持续病毒学应答率。
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