聚乙二醇化干扰素联合利巴韦林治疗基因型1b及6a慢性丙型肝炎的血液系统不良反应对比

Hematological System Adverse Reactions of Pegylated Interferon Combined with Ribavirin in Treatment of Genotype 1b and 6a Chronic Hepatitis C

目的对比两种聚乙二醇化干扰素(PEG-IFN)分别联合利巴韦林治疗慢性丙型肝炎的血液系统不良反应。方法共收集171例慢性丙型肝炎患者,其中140例采用PEG-IFN-2b(佩乐能)治疗,1.5 g/kg皮下注射,1次/周;31例采用PEG-IFN-2a(派罗欣)治疗,180 g皮下注射,1次/周。两组均联合利巴韦林治疗,剂量:PEG-IFN-2b组≥10.6 mg.kg-1.d-1,PEG-IFN-2a组为800～1 200 mg/d,口服,总疗程为48周。定期随访,观察药物不良反应,尤其对血液系统的影响。结果 171例患者均完成治疗,联合治疗后血液系统明显的不良反应/骨髓抑制的发生情况:中性粒细胞≤0.75×109/L发生率为12.87%,血红蛋白≤10 g/L发生率为16.96%;血小板≤50×109/L发生率为12.28%,经调整用药方案后血象均改善,患者均能坚持完成疗程。PEG-IFN-2b组和PEG-IFN-2a组的不良反应发生率:中性粒细胞≤0.75×109/L为12.06%vs.12.90%(P=1.000);血红蛋白≤10 g/L为17.02%vs.16.12%(P=0.892);血小板≤50×109/L为11.35%vs.16.12%(P=0.544)。HCV基因1b和6a不良反应发生率:中性粒细胞≤0.75×109/L为12.41%vs.15.38%(P=0.750);血红蛋白≤10 g/L为16.56%vs.19.23%(P=0.137);血小板≤50×109/L为11.72%vs.15.38%(P=1.000)。结论 PEG-IFN-2b与PEG-IFN-2a联合利巴韦林治疗慢性丙型肝炎,不良反应发生率两种PEG-IFN比较无明显差异,基因型1b和6a间不良反应发生率也无明显差异,患者均可以耐受。

Objective To observe the hematological system adverse effects of 2 pegylated interferons（PEG-IFN） combined respectively with ribavirin in treatment of chronic hepatitis C（CHC）.Methods In 171 CHC patients,140 were given PEG-IFN-2b treatment,1.5 g/kg,1/week;31 given PEG-IFN-2a,180 g,1/week.Both groups received combined rivavirin treatment,≥10.6 mg·kg-1·d-1in PEG-IFN-2b groups,and 800～1 200 mg/d,orally,in PEG-IFN-2a group,the total treatment course lasted 48 weeks.Regular follow-up was carried out to observe adverse drug effects,especially on hematological system.Results All patients completed treatment.After combined treatment,obvious adverse reaction or incidence of bone marrow suppression occurring was as following：neutropenia≤0.75×109/L was 12.87%,hemoglobin≤10 g/L was 16.96%,platelet ≤50×109/L was 12.28%.After adjustment of medication program,hemogram improved.The incidence of adverse reactions of PEG-IFN-2b group and PEG-IFN-2a as following：neutropenia ≤0.75×109/L was 12.06% vs.12.90%（P=1.000）;hemoglobin ≤10 g/L was 17.02% vs.16.12%（P=0.892）,platelet ≤50×109/L was 11.35% vs.16.12%（P=0.544）.Adverse reaction of HCV gene 1b and 6a as following：neutropenia ≤0.75×109/L was 12.41% vs.15.38%（P=0.750）;hemoglobin ≤10 g/L was 16.56% vs.19.23%（P=0.137）,platelet ≤50×109/L was 11.72% vs.15.38%（P=1.000）.Conclusion When PEG-IFN-2b or PEG-IFN-2a combined with ribavirin in chronic hepatitis C,there is not significant difference in incidence of adverse reaction between 2 PEG-IFNs,nor between gene types 1b and 6a,which patients can tolerate.