聚乙二醇干扰素α-2b联合利巴韦林治疗肾移植后丙型肝炎9例的效果及安全性  

Safety and efficacy of pegylated interferon and ribavirin for chronic hepatitis C following renal transplantation

作　　者：王筱啸[1] 朱兰[1] 喻俊 陈松[1] 林正斌[1] 陈刚[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院器官移植研究所 教育部/卫生和计划生育委员会器官移植重点实验室,武汉430030 [2]武汉医药卫生学会联合办公室

出　　处：《中华器官移植杂志》2014年第7期416-420,共5页Chinese Journal of Organ Transplantation

基　　金：国家高技术研究发展计划（2012AA021010）

摘　　要：目的 探讨聚乙二醇干扰素α-2b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 对9例肾移植术后1年以上、合并丙型肝炎、血肌酐稳定在正常范围的受者,采用聚乙二醇干扰素α-2b（50 μg皮下注射,每周1次）联合利巴韦林（400～600mg/d口服）治疗.每月检测丙型肝炎病毒（HCV） RNA,HCV RNA转阴后继续巩固治疗3～9个月.观测病毒学应答情况,同时观察肝肾功能、血常规变化及治疗过程中的不良反应.结果 9例受者的总疗程为4～20个月,其中6例（66.7％）获得满意的持续病毒学应答（完全应答）,随访至停用干扰素治疗后6个月未出现复发;2例在获得快速病毒学应答后,于巩固治疗3个月停止治疗后复发;1例在治疗8个月的过程中未见明显病毒学应答.治疗中所有受者的血肌酐水平均在正常范围内波动,所有受者均未出现急性排斥反应迹象.治疗过程中的主要不良反应包括流感样症候群（发热、肌肉酸痛、食欲不振等）、一过性骨髓抑制以及贫血等.所有不良反应未经处理或经对症处理后均可缓解或耐受.结论 聚乙二醇干扰素α-2b联合利巴韦林治疗肾移植后合并丙型肝炎的移植肾功能稳定受者有确切疗效,对移植肾功能无明显影响,无严重不良反应,较为安全.Objective To investigate the safety and efficacy of pegylated interferon （PEG-IFN） and ribavirin for chronic hepatitis C following renal transplantation.Method Nine adult renal transplant recipients of ＞ 12-month duration,infected with hepatitis C virus （HCV）,and with stable renal graft function were recruited.All patients were administered with PEG-IFN-α 2b 50 μg/week,plus ribovirin 400-600 mg/day.HCV viral load was reexamined monthly.Consolidation therapy lasted for 3-9 months after initial remission of HCV-RNA.Viral response,adverse effects and changes in hemogram,alanine aminotransferase and andserum creatinine were also monitored.Result The duration of treatment for 9 patients was 4-20 months.Sustained virologic response （SVR） occurred in 6 patients with no relapse during 6-month follow up period after the ceasation of the treatment.Two patients,with rapid virologic response,had a virologic relapse after completing their 3-month consolidation therapy.One patient maintained no obvious virologic response during 8 months of treatment.Renal function was kept in normal range in all patients and no one experienced a rejection episode during or after PEG-IFN-α 2b therapy.The major adverse reactions included influenza-like syndrome （fever,muscle soreness,anorexia）,transient bone marrow suppression and anemia.All of the adverse reactions were transient and tolerable,and no discontinuation of PEG-IFN-a 2b therapy was required in all these patients.Conclusion For renal transplant recipients with stable renal graft function,treatment with PEG-IFN-α 2b and ribavirin has high efficacy in the treatment of HCV and is not associated with high risk of acute rejection of renal allografts.

关 键 词：肾移植 丙型肝炎 治疗结果 

分 类 号：R699.2[医药卫生—泌尿科学] R512.63[医药卫生—外科学]