粒细胞集落刺激因子联合聚乙二醇干扰素α-2b、利巴韦林治疗中性粒细胞绝对值减少丙肝肝硬化代偿期患者的临床观察  

Clinical study of G-CSF combined with PegIFNα-2b and Ribavirin in patients with hepatitis C-related compensated cirrhosis with neutropenia

作　　者：朱云[1] 李明英[2] 王春平[1] 李茵茵[1] 张敏娜[1] 高旭东[1] 杨永平[1] 

机构地区：[1]解放军302医院肝癌治疗研究中心,北京100039 [2]吉林省辽源市第二人民医院内科

出　　处：《胃肠病学和肝病学杂志》2010年第10期893-895,共3页Chinese Journal of Gastroenterology and Hepatology

基　　金：军队医学杰出人才基金(04J020)

摘　　要：目的评价粒细胞集落刺激因子(G-CSF)联合聚乙二醇干扰素α-2b(PegIFNα-2b)、利巴韦林治疗中性粒细胞绝对值≤1.00×109/L丙肝肝硬化代偿期患者的有效性、安全性。方法 24例中性粒细胞绝对值≤1.00×109/L丙肝肝硬化代偿期患者,予皮下注射PegIFNα-2b 80μg/周(体重<60 kg,剂量为50μg/周)和口服利巴韦林(300 mg,3次/d),应用PegIFNα-2b前后1天各皮下注射G-CSF 200μg,治疗24周并随访24周。结果 7例因依从性差、1例因严重皮疹而终止治疗。余16例患者完成治疗和随访,其中仅1例出现轻度胸骨疼痛,无1例出现肝功能失代偿或严重感染。在应用G-CSF后,中性粒细胞绝对值即升至干扰素适应范围内;治疗期间每周第7天平均中性粒细胞绝对值为(1.49±0.32)×109/L;治疗结束后第12、24周中性粒细胞绝对值与抗病毒治疗前比较无差异(P>0.05)。治疗后谷丙转氨酶(ALT)恢复正常。早期病毒学应答率、治疗终点病毒学应答率、持续病毒学应答率分别为81.2%、75.0%、62.5%。结论 G-CSF联合PegIFNα-2b、利巴韦林抗病毒治疗可有效、安全地应用于中性粒细胞绝对值减少丙肝肝硬化代偿期患者。Objective To evaluate the efficacy and safety of Granulocyte colony-stimulating factor（G-CSF） combined with PegIFNα-2b and Ribavirin in patients with hepatitis C-related compensated cirrhosis with neutrophil count less than 1.00 × 109 /L.Methods Twenty-four patients with hepatitis C-related compensated cirrhosis with neutropenia were given PegIFNα-2b weekly according to bodyweight in doses of 80 μg（≥60 kg） or 50 μg（ 60 kg）,Ribavirin 300 mg tid,and G-CSF（200 μg） 1 day before and after each dose of PegIFNα-2b.The course of treatment was 24 weeks and a follow-up of 24 weeks.Results Eight patients dropped off due to poor compliance（7 patients） and severe eruption（1 patient）.Sixteen patients finished treatment and follow-up.Only 1 case occurred mild sternal pain,and decompensation of liver function or severe infecion was not observed.The neutrophil count immediately increased after treated with G-CSF;the average neutrophil count of the seventh day every week during treatment was（1.49 ± 0.32） × 109 /L.No significant change was found in the neutrophil counts before and after treatment（P 0.05）.The ALT value was reduced to normal range rapidly after the treatment.The early virological response（EVR） rate,end of treatment virological response（ETVR） rate and sustained virological response（SVR） rate were 81.2%,75.0%,62.5%.Conclusion G-CSF combined with PegIFNα-2b and Ribavirin is safe and effective to patients with hepatitis C-related compensated cirrhosis with neutropenia.

关 键 词：丙肝肝硬化 代偿期 中性粒细胞 粒细胞集落刺激因子 聚乙二醇干扰素Α-2B 

分 类 号：R575.2[医药卫生—消化系统]