慢性丙型病毒性肝炎干扰素抗病毒治疗外周血的变化特征及与疗效关系  

Changes in peripheral blood during the antiviral treatment with Peg-IFNα-2 a and ribavirin for patients with chronic hepatitis C and the relationship between the changes and effect

作　　者：李真真 郝红晓 张璐 路遥 曹卫华 王星月 冉崇平 齐天林 吴淑玲 申戈 刘如玉 常敏 胡蕾苹 李明慧 谢尧 

机构地区：[1]首都医科大学附属北京地坛医院肝病中心肝病二科,北京100015

出　　处：《中华实验和临床病毒学杂志》2017年第6期545-548,共4页Chinese Journal of Experimental and Clinical Virology

基　　金：北京市医院管理局临床技术创新项目（XMLX201706）

摘　　要：目的 探讨聚乙二醇化干扰素α-2 a联合利巴韦林治疗慢性丙型病毒性肝炎患者时外周血象变化的规律,评估外周血象变化规律对于治疗效果的影响.方法 收集就诊于北京地坛医院肝病二科聚乙二醇化干扰素α-2 a联合利巴韦林治疗慢性丙型病毒性肝炎患者418例（包含代偿期肝硬化59例）,收集基线水平、治疗2周、4周、8周、12周、24周、36周、48周、治疗结束、治疗结束后12周、治疗结束后24周、治疗结束后48周患者血常规、肝功能、肾功能、甲状腺功能等常规指标,HCVRNA等指标并进行统计分析.结果 应用聚乙二醇化干扰素α-2 a联合利巴韦林治疗的慢性丙型病毒性肝炎患者,外周血细胞均于治疗第2周开始出现明显下降;②对于慢性丙型病毒性肝病患者,无肝硬化者白细胞、淋巴细胞、血小板、血红蛋白均于治疗第36周下降至最低值,中性粒细胞于24周下降至最低值,各个指标均于停药后开始恢复正常,停药48周时大致恢复至基线水平;对于有肝硬化者,血红蛋白、血小板均于治疗第24周下降至最低值,白细胞于24 ～ 36周下降至最低值,淋巴细胞于第36周下降至最低值,中性粒细胞于第2周下降至最低值,各个指标均于结束治疗后开始恢复正常,停药48周基本恢复至基线水平;③对于慢性丙型病毒性肝病,4周血红蛋白下降幅度＞ 27.46％、8周血小板下降幅度＞ 36.96％对于SVR率有一定的预测作用.结论 外周血的变化规律对于慢性丙型病毒性肝炎应用聚乙二醇化干扰素α-2 a抗病毒治疗疗效有一定的预测作用.Objective To observe the changes of peripheral blood image of chronic hepatitis C （CHC） patients treated with pegylated interferon （Peg-IFN） and ribavirin,and explore the relationship between the changes and serum virological respose （SVR）.Methods Patients with CHC treated with PegIFN α-2 a and ribavirin in the Second Division of Liver Disease in Beijing Ditan Hospital were monitored for peripheral blood cells routine examination and Liver function,kidney function,thyroid function at baseline and week 2,4,8,12,24,36,48,and week 12,24,48 after the end of treatment for chronic hepatitis C,and HCV RNA.Results The decrease of peripheral blood cell counts began to appear at week 2 of treatment.For CHC patients without cirrhosis,white blood cells,lymphocyte,hemoglobin and platelets at week 2,while minimum values were seen at week 36,and the neutrophils reached the minimum value to at week 24.Significant recovery of the peripheral blood changes was seen at the end of treatment （48 weeks）,and reached pre-treatment levels at week 48 after the end of treatment.For CHC patients with cirrhosis,white blood cells,lymphocytes,hemoglobin and platelets significantly decreased at week 2,while neutrophils reached a minimum value at 2 weeks.And hemoglobin and platelets reached a minimum value at 24 weeks,and the white blood cells reached the minimum value at weeks 24-36 besides lymphocyte reached the minimum value at week 36.Significant recovery was seen at the end of treatment （48 weeks）,and the blood cell counts reached pre-treatment levels at 48 weeks after the end of treatment.For patients with CHC,hemoglobin decreased by more than 27.47％ at week 4,which means that the patient would have a predictive significance for SVR,as well as the of PLT reduction by more than 36.96％ at week 8.Conclusions During the treatment with Peg-interferon and ribavirin,the variation of blood picture has some predicting effect,which predicts the result of antiviral treatment.

关 键 词：肝炎 丙型 慢性 聚乙二醇化干扰素α-2 a 外周血象 HCV RNA SVR 

分 类 号：R512.63[医药卫生—内科学]