小剂量PEG-INF-α-2α联合利巴韦林治疗肾移植后丙型肝炎的疗效及安全性  

Safety and efficacy of low dose peginterferon-aipha-2a combined with Ribavirin treating chronic hepatitis C in renal transplant recipients

作　　者：马俊杰[1] 李光辉[1] 徐璐[1] 张磊[1] 陈正[1] 方佳丽[1] 潘光辉[1] 

机构地区：[1]广州医学院第二附属医院移植科,510260

出　　处：《中华器官移植杂志》2012年第9期548-551,共4页Chinese Journal of Organ Transplantation

摘　　要：【摘要】目的探讨小剂量聚乙二醇干扰素α-2α（PEC-INF-α-2α）联合利巴韦林治疗肾移植后丙型肝炎的疗效及安全性。方法移植前血清抗丙型肝炎病毒（HCV）抗体阳性和（或）HCVRNA持续阳性者13例，随机分为试验组（7例）和对照组（6例），试验组术后给予PEG-INF-α-2α和利巴韦林治疗16周，其中4例延长至48周；对照组给予普通护肝和抗炎治疗；两组均随访2年以上。结果试验组治疗16周后有5例获得早期应答，其中4例获得完全应答，没有无效病例，明显优于对照组；丙氨酸转氨酶和天冬氨酸转氨酸基本正常，明显好于对照组。4例治疗48周者，1例35周时因严重面部肌肉痛并血肌酐升高，病理证实为体液性排斥反应，停止治疗；1例38周时因HCVRNA复制增加，停止治疗。试验组治疗后2年时5例达到完全应答，其中2例抗HCV抗体转阴，HCVRNA明显低于对照组，肝功能基本维持正常，血肌酐高于对照组（P〉0．05）。该方案治疗的不良反应有发热、肌肉痛、粒细胞缺乏症和（或）贫血和体液性排斥反应，经停药和对症处理痊愈。结论小剂量PEG-INF-α-2α联合利巴韦林对肾移植合并丙型肝炎者有明确疗效，16周的疗程效果较为理想，但应注意PEG-INF-α-2α可诱发体液性排斥反应和致血肌酐爬行升高。Objective To study the safety and efficacy of low dose Peginterferon-alpha 2α （PEG-INF-α-2α） combined with Ribavirin treating chronic hepatitis C in renal transplant recipients. Methods A total of 13 cases of HCV hepatitis were randomly divided into treatment and control groups. Seven cases in treatment group were given PEC-INF-α-2α （90 μg/week） and ribavirin （600 μg/day） for 16 to 48 weeks, and the rest 6 eases in control group were subjected to general liver protection and anti inflammatory treatment. All patients were followed up for more than 2 years. Results There were 5 cases getting early response in treatment group for 16 weeks, including four cases of complete response and no non-effects response patients. In 4 cases voluntarily receiving treatment for 48 weeks, I case had facial muscle myalgia and increased Cr level at 35th week, humoral graft rejection was confirmed pathologically, and the treatment was terminated; 1 case had recurrence of HCV-RNA replication and PEG-INF-a-2a was withdrawn at 38th week. As results, 5 patients in the treatment group obtained complete response after two years, including 2 cases whose HCV-IgG had got negative, HCV RNA replication was significantly lower than in the control group, and the average Cr higher than in control group （P 〉 0. 05）. There were adverse reactions during this treatment protocol： fever, muscle myalgia, agranulocytosis, anemia and humoral graft rejection. Conclusion The efficacy of low dose PEG-INF-α-2a combined with ribavirin is definite in the treatment of chronic HCV hepatitis in kidney transplant recipients. The 16-week treatment duration is reasonable. It is remarkable that PEG-INF-α-2α may cause humoral graft rejection and Cr crawling.

关 键 词：肾移植 聚乙烯二醇类 干扰素Α-2A 利巴韦林 丙型肝炎病毒 治疗效果 

分 类 号：R512.63[医药卫生—内科学]