小剂量α-干扰素联合利巴韦林治疗丙型肝炎肝硬化脾功能亢进的疗效与安全性

Low-dose interferon-α and ribavirin for hepatitis C cirrhosis and hypersplenism

目的:观察应用α-干扰素(IFN-α)小剂量开始逐渐加量联合利巴韦林治疗丙型肝炎肝硬化代偿期脾功亢进的临床疗效及安全性。方法:14例丙型肝炎肝硬化脾功亢进患者采用IFN-α加利巴韦林治疗。IFN-α1MU,隔日一次,皮下注射,两周后对耐受良好的患者,将IFN-α剂量增加至2MU,以后如能够耐受,则每4周增加1MU,直至5MU,如不能耐受增加剂量,则按原剂量治疗,疗程一年。利巴韦林开始剂量600mg/d,如能耐受逐渐增加至900～1200mg/d,不能耐受按原剂量治疗,疗程一年。观察基因型、血常规、肝功能、HCV-RNA及不良。结果:14例患者,8例为基因lb型;6例为基因2a型。12例患者完成一年疗程。8例出现病毒学应答,应答率66.7%,HCV-RNA平均下降3.6±1.7log10,SVR33.3%,肝功能复常率75%,白细胞、血小板治疗前后比较差异无统计学意义。无不良事件发生。1例合并特发性血小板减少性紫癜(ITP)患者白细胞、血小板恢复正常,PAIg-G明显下降。结论:丙型肝炎肝硬化脾功能亢进患者可选择小剂量IFN-α联合利巴韦林逐渐加量治疗方案治疗,未见明显不良反应。

Objective：To observe the efficacy of interferon-α（IFN-α）plus ribavirin on patients with hepatitis C-related compen-sated cirrhosis hypersplenism with a low accelerating dose regimen.Methods：14 patients with compensated cirrhotic hypersplenism were selected and treated with IFN-α.1MU IFN-α is given third a week in 14 days.Then 2MU IFN-α were given if there were not side effects.Each additional 1MU IFN-αup to 5MU per 4 weeks if there are no side effect.Otherwise,the original dose is given for one year.The initial dose of ribavirin were 600mg daily for 1 month.For the patients tolerated,the treatment of ribavirin at 900-1200mg/d,respec-tively continued for 12 months.Genotype,blood routine,liver function,HCV-RNA were detected before and after treatment.Results：8 patients are gene lb and others are gene 2a.12 of them completed one year treatment course.Virological response rate was 66.7%,the load of HCV-RNA average drop 3.6±1.7log10,The sustained virological response rate was 33.3%.75% of the patients liver function were restored to normal levels after IFN-α regulation.Conclusions：The low-accelerating dose regimen of IFN-α plus ribavirin is effec-tive for the treatment of compensated cirrhotic hepatitis C with hypersplenism.No severe adverse effect was encountered.