Cattral M S, Krajden M, Wanless I R, Rezig M, Cameron R, Greig P D, Chung S W, Levy G A
Department of Surgery, Liver Transplant Programme, The Toronto Hospital, University of Toronto, Ontario, Canada.
Transplantation. 1996 May 27;61(10):1483-8. doi: 10.1097/00007890-199605270-00013.
Ribavirin is a guanosine analogue that normalizes serum liver enzymes in most nontransplant patients with chronic hepatitis C virus (HCV) infection. We conducted an uncontrolled pilot study of ribavirin in 9 liver transplantation recipients that had persistently elevated liver enzymes, active hepatitis by liver biopsy, and HCV RNA in serum by polymerase chain reaction. Ribavirin was given orally at dosages of 800-1200 mg per day for 3 mo. All 9 patients promptly responded to ribavirin: mean (+/- SD) ALT decreased from 392 +/- 377 IU/L immediately before treatment to 199 +/- 185 and 68 +/- 37 IU/L after 1 and 12 weeks of treatment, respectively, complete normalization of enzymes occurred in 4 patients. None of the patients cleared the virus from their serum during therapy, and biochemical relapse occurred in all patients 4 +/- 4.2 weeks after cessation of therapy. The hepatitis activity index of liver biopsy specimens obtained before and at the cessation of therapy was similar. Ribavirin treatment was resumed in 4 patients because of increasing fatigue (2 patients), rising bilirubin (3), or increasing necroinflammation on liver biopsy (2); the biochemical response to the second course of therapy was similar to the first course in all 4 patients. Ribavirin caused reversible hemolysis in all patients, including symptomatic anemia in 3 patients that resolved after reduction of drug dosage. These results suggest that ribavirin may be of benefit in the treatment of HCV infection after liver transplantation. Further studies are needed to determine the optimal dosage and duration of therapy.
利巴韦林是一种鸟苷类似物，可使大多数慢性丙型肝炎病毒（HCV）感染的非移植患者血清肝酶恢复正常。我们对9例肝移植受者进行了一项关于利巴韦林的非对照试验研究，这些患者肝酶持续升高、肝活检显示有活动性肝炎且通过聚合酶链反应检测血清中有HCV RNA。利巴韦林以每日800 - 1200 mg的剂量口服，持续3个月。所有9例患者对利巴韦林均迅速产生反应：治疗前平均（±标准差）丙氨酸氨基转移酶（ALT）为392±377 IU/L，治疗1周和12周后分别降至199±185 IU/L和68±37 IU/L，4例患者酶完全恢复正常。治疗期间无患者血清病毒清除，所有患者在治疗停止后4±4.2周出现生化复发。治疗前及治疗停止时获取的肝活检标本的肝炎活动指数相似。4例患者因疲劳加重（2例）、胆红素升高（3例）或肝活检显示坏死性炎症加重（2例）而恢复利巴韦林治疗；所有4例患者对第二疗程治疗的生化反应与第一疗程相似。利巴韦林在所有患者中均引起可逆性溶血，包括3例出现症状性贫血，在减少药物剂量后症状缓解。这些结果表明，利巴韦林可能对肝移植后HCV感染的治疗有益。需要进一步研究以确定最佳治疗剂量和疗程。
