| 摘要: | 背景與目的：現今治療慢性C型肝炎的選擇是注射長效型干擾素合併口服雷巴威林治療。聯合抗病毒治療方法的一個主要副作用是貧血，貧血通常將影響生活品質，此時則需要調整雷巴威林劑量。因此我們進行這回溯性研究，來探討貧血發生的機率與其相關的危險因子，同時也探討有關接受抗病毒治療成功機會的相關因素。
方法：總共有四百五十七名慢性C型肝炎病人完成接受注射長效型干擾素α-2a(干擾素α -2a）或長效型干擾素α-2b (干擾素α -2b)合併雷巴威林口服治療24或48星期。血紅素低於10 g/dL以下被定義是嚴重貧血。
結果：總共有40.5%患者在治療過程中曾有嚴重貧血的現象。血紅素平均減少了4.17 ± 1.59 g/dL。多元分析顯示出，年齡大於50歲，治療前血紅素大於14 g/dL 和男性性別與最大血紅素跌幅有關。利用Log-rank test可以知道年齡大於50歲，女性性別，血紅素小於14 g/dL，體重小於60 公斤，白血液小於4000/mm3，白蛋白小於3.5 g/dL，肌酐酸大於1.3 mg/dL和肝功能ALT <40 U/L是嚴重貧血的危險因子。使用Cox回歸分析，我們發現年齡大於50歲，血紅素小於14 g/dL和肌酐酸大於1.3 mg/dL與嚴重貧血有相關性。利用回歸分析方法，我們知道基因型，病毒量及肝功能ALT與快速病毒反應有相關性，與早期病毒反應有相關的則是病毒基因型與最大血紅素跌幅，與持續病毒反應有關的有病毒基因型、血中白蛋白濃度與纖維化程度。整體來說患者接受平均雷巴威林劑量是與發生血紅素小於10 g/dL的時間點有相關性，發生嚴重貧血的時間越晚則服用劑量越高。
結論：年齡大於50歲患者，肌酐酸大於1.3 mg/dL和血紅素小於14 g/dL是在接受抗C型病毒治療過程中發生嚴重貧血的有意義相關因素。接受長效型干擾素合併口服雷巴威林治療C型病毒的患者如果有這些危險因子需注意嚴重貧血的發生。
Background and Aims: The current treatment of choice for chronic hepatitis C is the combination of pegylated interferon and ribavirin. One major side effect of combination antiviral therapy is anemia that will influence life quality and usually needs dose reduction of ribavirin. Therefore, we conducted this retrospective study to determine the incidence, risk factors of anemia, and treatment responses in chronic hepatitis C receiving combination antiviral therapy.
Methods: Four hundred and fifty-seven chronic hepatitis C patients who completed pegylated interferonα-2a (IFNα-2a) or pegylated IFNα-2b (IFNα-2b) combined with ribavirin therapy for 24 or 48 weeks were included in this study. Hemoglobin below 10 g/dL was considered as severe anemia.
Results: A total of 40.5% patients had severe anemia during combination therapy. The mean decrease of hemoglobin was 4.17 ± 1.59 g/dL. Old age (≧50 years), pretreatment hemoglobin ≧14 g/dL, and male gender were significantly correlated with maximal decreases in hemoglobin by multivariate analysis. Log rank tests showed that old age (≧50 years), female gender, hemoglobin <14 g/dL, body weight <60 kg, white blood count <4000/mm3, albumin ≦3.5 g/dL, creatinine >1.3 mg/dL and ALT <40 U/L were significant risk factors of severe anemia. Using Cox regression analysis, we found that old age, hemoglobin <14g/dL, and creatinine >1.3 mg/dL were significant independent factors associated with severe anemia. In our study, genotype, viral load and ALT were independent factors associated with RVR. Genotype and maximal decrease in hemoglobin were associated with EVR. The significant factors related to SVR were genotype, albumin, and fibrosis stage by stepwise logistic regression analysis. The overall average ribavirin dose was significantly correlated with the time of hemoglobin level below 10 g/dL during antiviral therapy.
Conclusion: Age over 50 years, creatinine >1.3 mg/dL, and hemoglobin level below 14 g/dL were significant factors associated with severe anemia during antiviral therapy. Careful monitoring is necessary for patients with these risk factors. |
