干扰素α-2b联合利巴韦林治疗后慢性丙型肝炎患者外周血细胞数量的变化及其临床意义

doi:10.13481/j.1671-587x.20150332

吉林大学学报(医学版) ›› 2015, Vol. 41 ›› Issue (03): 599-605.doi: 10.13481/j.1671-587x.20150332

干扰素α-2b联合利巴韦林治疗后慢性丙型肝炎患者外周血细胞数量的变化及其临床意义

马琳媛¹, 张鹏², 陈倩¹, 孔文丽¹, 杨以良¹, 李玉香², 潘煜¹

1. 吉林大学第一医院肝胆胰内科, 吉林长春 130021;
2. 吉林大学第一医院感染症科, 吉林长春 130021

收稿日期:2014-11-05 发布日期:2015-08-01
通讯作者: 潘煜,教授,硕士研究生导师(Tel:0431-81175114,E-mail:panyu20000@163.com) E-mail:panyu20000@163.com
作者简介:马林媛(1988-),女,河南省南阳市人,医学硕士,主要从事肝脏疾病诊治方面的研究。
基金资助:
国家自然科学基金资助课题(81072347)

Changes in number of peripheral blood cells in patients with chronic hepatitis C after treated with interferon alpha 2b combined with ribavirin and their clinical significances

MA Linyuan¹, ZHANG Peng², CHEN Qian¹, KONG Wenli¹, YANG Yiliang¹, LI Yuxiang², PAN Yu¹

1. Department of Hepatis-Biliary-Pancreas Medicine, First Hospital, Jilin University, Changchun 130021, China;
2. Department of Infectious Diseases, First Hospital, Jilin University, Changchun 130021, China

Received:2014-11-05 Published:2015-08-01

摘要/Abstract

摘要：

目的:探讨干扰素α-2b(INF-α2b)联合利巴韦林治疗后慢性丙型肝炎患者外周血细胞数量的变化,阐明影响外周血细胞数量的相关因素。方法:选择343例慢性丙型肝炎患者(有慢性肝炎的症状且抗-HCV和HCV-RNA阳性),均给予药物INF-α 2b 500 万U、隔日1次、皮下注射,利巴韦林 15 mg·kg^-1·d^-1 口服,疗程48周;在基线、2周、12周、24周、36周和48周对患者进行血常规、HCV RNA定量等检测,治疗后60、72和96周进行随访。出现中性粒细胞绝对值数减少、贫血及血小板计数减少的患者依据《2010丙型肝炎防治指南》进行相应治疗或随访观察。结果:治疗过程中中性粒细胞减少症发病率为40.5%(139例),贫血发病率为48.4%(166例),血小板减少症发病率为39.9%(137例)。治疗结束后仍有个别患者出现外周血细胞数量改变。抗病毒治疗过程中,外周血细胞数量减少多出现在治疗开始至12周内。治疗2周内中性粒细胞、血红蛋白和血小板计数即有明显下降,至第12周时同时降到最低值,12周后出现缓慢上升,治疗结束时(48周)虽较12周恢复明显,但仍未达到治疗前水平,60~72周时趋于平稳且恢复到治疗前水平。基线中性粒细胞绝对值、血小板计数、天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、肝纤维化程度与中性粒细胞减少症的发生及严重程度有关联(P<0.05)。性别与贫血的发生有关联,基线血红蛋白水平与贫血的发生及严重程度均有关联(P<0.05)。性别、基线中性粒细胞绝对值、血小板计数、AST、ALT、γ-谷氨酰转肽酶(γ-GT)、肝纤维化程度与血小板减少症的发生有关联(P<0.05)。结论:抗病毒治疗2周内慢性丙型肝炎患者外周血细胞数量即有明显下降,12周时降至最低,临床医生应及时对患者进行随访及干预,避免严重不良事件的发生。根据基线性别、外周血细胞水平、肝功能和肝纤维化程度可评估抗病毒过程中患者外周细胞数量是否减少及严重程度。

关键词: 干扰素&alpha, -2b, 利巴韦林, 慢性丙型肝炎, 外周血细胞

Abstract:

Objective To explore the changes in the number of peripheral blood cells in the patients with chronic hepatitis C(CHC) after treated with interferon alpha 2b(IFN-α2b) combined with ribavirin, and to clarify the impact factors of the number of peripheral blood cells. Methods A total of 343 CHC patients with symptoms of chronic hepatitis and positive anti -HCV and HCV RNA were selected.All patients received IFN-α2b (5 000 000 U, every other day, subcutaneous)combined with ribavirin (15 mg·kg^-1·d^-1, oral)for 48 weeks.The number of peripheral blood cells and serum HCV RNA level were assessed at 12, 24, 36, 48, 60, 72, and 96 weeks.The patients who developed neutropenia, anemia and thrombocytopenia would be treated according to "2010 Hepatitis C Treatment Guidelines". Results The prevalence of neutropenia, anemia and thrombocytopenia were 40.5%(139), 48.4%(166) and 39.9%(137), respectively.There were changes in the number of peripheral blood cells of individual patients after treatment.The most of changes occured from the beginning to 12 weeks.The number of neutrophils, hemoglobin and plateletsin were significantly decreased in 2 weeks, while the minimum value appeared at the 12th weeks followed by a slow rise.At the end of treatment (48 weeks), although the recovery was obvious, but not yet reached the pre-treatment levels.They recoved to the pre-treatment levels at 60 to 72 weeks.The baseline of absolute neutrophil count(ANC), plateletsin(PLT), aspartate transaminase(AST), alanine transaminase(ALT) and liver fibrosis were associated with neutropenia (P<0.05).The gender and baseline of hemoglobin levels were related to anemia(P<0.05).Gender, baseline of ANC, PLT, AST, ALT, γ-glutamyl transferase (γ-GT) and liver fibrosis were associated with thrombocytopenia(P<0.05). Conclusion The number of peripheral blood cells is significantly decreased in 2 weeks after anti-virus therapy, and reaches a minimum at 12 weeks, which reminds that clinicians should perform intervention and follow up timely to avoid serious adverse events.The occurrence and severity of reduction in the number of peripheral blood cells could be assessed according to the baseline gender, level of peripheral blood cells, liver function and liver fibrosis.

Key words: interferon alpha 2b, ribavirin, chronic hepatitis C, peripheral blood cells

中图分类号:

R575.1

马琳媛, 张鹏, 陈倩, 孔文丽, 杨以良, 李玉香, 潘煜. 干扰素α-2b联合利巴韦林治疗后慢性丙型肝炎患者外周血细胞数量的变化及其临床意义[J]. 吉林大学学报(医学版), 2015, 41(03): 599-605.

MA Linyuan, ZHANG Peng, CHEN Qian, KONG Wenli, YANG Yiliang, LI Yuxiang, PAN Yu. Changes in number of peripheral blood cells in patients with chronic hepatitis C after treated with interferon alpha 2b combined with ribavirin and their clinical significances[J]. Journal of Jilin University Medicine Edition, 2015, 41(03): 599-605.

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干扰素α-2b联合利巴韦林治疗后慢性丙型肝炎患者外周血细胞数量的变化及其临床意义

Changes in number of peripheral blood cells in patients with chronic hepatitis C after treated with interferon alpha 2b combined with ribavirin and their clinical significances

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