Pol S, Thiers V, Carnot F, Zins B, Roméo R, Berthelot P, Bréchot C
Hepatology Unit, Hopital Necker, Paris, France.
Nephrol Dial Transplant. 1996;11 Suppl 4:58-61. doi: 10.1093/ndt/11.supp4.58.
Twenty-five per cent of haemodialysed patients carry anti-HCV antibodies; these antibodies are associated with detectable viraemia in 85% and chronic hepatitis in 90% of subjects, despite normal transaminases in more than half of them. This underlines the importance of antiviral therapy. We evaluated the tolerance and effectiveness of a classic interferon (IFN) treatment (3 MU three times a week for 6 months, subcutaneously) in 19 haemodialysis patients presenting with anti-HCV antibodies and chronic (n = 16) or acute (n = 3) hepatitis. Thirteen of those 19 patients had elevated transaminases. Viraemia C was detected by genome amplification (PCR) and by the bDNA test before and after interferon therapy as well as 6 months at least after the end of INF treatment. Response (defined as liver enzyme normalization) was noted in 11 (84.6%) of the 13 patients with elevated transaminases; at the end of follow-up, six exhibited long-term response and five had relapsed, HCV-RNA was detected in 15 of the 19 patients before IFN therapy and remained positive in 7/15 initially viraemic patients at the end of treatment. Hepatitis C RNA was detected at the last follow-up visit (mean follow-up duration 18 +/- 9 months) in 12 of the 15 initially viraemic patients. Liver histology was improved in most patients, regardless of their biological response. One patient could not complete the 6-month course because of clinical and haematological adverse events. In the six patients with strictly normal transaminases, HCV RNA was detectable in 4/6 patients before treatment, in 2/4 viraemic patients at the end of treatment, and in 4/4 at the last follow-up visit. All pathological signs disappeared in four of the five patients who had no detectable HCV-RNA before IFN therapy. To conclude: (i) interferon-alpha exhibits satisfactory effectiveness and tolerance in haemodialysed patient; (ii) HCV replication recurs in most of these patients despite histological improvement; (iii) interferon-alpha can be effective even in patients with chronic hepatitis and no detectable HCV-RNA.
25%的血液透析患者携带抗丙型肝炎病毒（HCV）抗体；这些抗体与85%的患者可检测到病毒血症以及90%的患者患慢性肝炎相关，尽管其中一半以上患者的转氨酶正常。这突出了抗病毒治疗的重要性。我们评估了经典干扰素（IFN）治疗（每周3次，每次300万单位，皮下注射，共6个月）对19例携带抗HCV抗体且患有慢性（n = 16）或急性（n = 3）肝炎的血液透析患者的耐受性和有效性。这19例患者中有13例转氨酶升高。在干扰素治疗前后以及至少在INF治疗结束后6个月，通过基因组扩增（PCR）和分支DNA（bDNA）检测法检测C型病毒血症。13例转氨酶升高的患者中有11例（84.6%）出现反应（定义为肝酶恢复正常）；随访结束时，6例表现为长期反应，5例复发。19例患者中有15例在干扰素治疗前检测到HCV-RNA，治疗结束时，15例最初有病毒血症的患者中有7例仍为阳性。在最后一次随访（平均随访时间18±9个月）时，15例最初有病毒血症的患者中有12例检测到丙型肝炎病毒RNA。大多数患者的肝脏组织学得到改善，无论其生物学反应如何。1例患者因临床和血液学不良事件未能完成6个月疗程。在6例转氨酶完全正常的患者中，4/6的患者在治疗前可检测到HCV RNA，2/4的病毒血症患者在治疗结束时仍可检测到，4/4的患者在最后一次随访时仍可检测到。在干扰素治疗前未检测到HCV-RNA的5例患者中，有4例患者的所有病理体征均消失。总之：（i）α干扰素在血液透析患者中表现出令人满意的有效性和耐受性；（ii）尽管组织学有所改善，但这些患者中的大多数仍会出现HCV复制复发；（iii）α干扰素即使对慢性肝炎且未检测到HCV-RNA的患者也可能有效。
