聚乙二醇干扰素α-2a联合利巴韦林治疗慢性丙型肝炎期间中性粒细胞减少症与临床感染风险的相关性

A study of the relationship between neutropenia and clinical infection risk during treatment withpeginterferon alfa-2a and ribavirin for chronic hepatitis C

目的研究聚乙二醇干扰素（PEG—IFN）et-2a联合利巴韦林治疗慢性丙型肝炎（CHC）期间中性粒细胞（ANC）减少症发生率及其与临床感染发生之间的关系。方法对哈尔滨医科大学附属第二医院进行PEG—IFNα-2α联合利巴韦林治疗的399例CHC患者进行回顾性分析，研究ANC减少症、临床感染的发生率及其之间的关系，分析影响临床感染发生的危险因素。结果治疗期间251例患者发生ANC减少症（ANC〈1．50×109／L），占62．9％。其中，轻度ANC减少症[ANC（〉0．75-〈1．50）X109／L]132例；中度ANC减少症[ANC（0．50-0．75）×109／L]103例；重度ANC减少症（ANC〈0．50×10’／L）16例。399例CHC患者中，80例（20．1％）发生临床感染，其中14例发生重度感染。伴有ANC减少症患者的临床感染发生率为19．9％（50／251）与未伴有ANC减少症的患者[20．3％（30／148）]相比，差异无统计学意义（x2=0．007，P=0．933）。调整PEG—IFNeα-2α剂量患者的临床感染发生率为21．5％（31／144），与未调整剂量患者[19．2％（49／255）]相比，差异无统计学意义（X。=0．307，P=0．580）。在多因素分析中，年龄（P：0．021）、糖尿病（P=0．004）和肝硬化（P=0．012）是影响CHC患者发生临床感染的独立危险因素。结论CHC患者抗病毒治疗期间临床感染的发生与ANC减少症无明显关系。年龄、糖尿病和肝硬化是预测CHC患者发生临床感染的危险因素。

[Abstract] Objective To investigate the corelation between neutropenia （ANC） incidence and infection during treatment with peginterferon alfa and ribavirin for chronic hepatitis C. Methods A retrospective cohort study of 399 patients treated with peginterferon and ribavirin derived from database of Department of Infectious Diseases, the Second Affiliated Hospital, Harbin Medical University was conducted. The incidence of infections and their relation with ANC were investigated. Potential risk factors for infection were identified by multivariate analysis. Results During treatment, neutropenia （ANC 〈 1.50 × 109/L） occurred in 251 patients. Among which, mild neutropenia [ ANC： （ 〉 O. 75-〈 1.50） × 109/L], moderate neutropenia [ ANC： （0. 50-0. 75 ） × 109/L / and severe neutropenia （ ANC 〈 0. 50 × 109/L） occurred in 132 patients, 103 patients and 16 patients, respectively. A total of 80 infections （20. 1% ） occurred, among which, 14 infections were defined as severe. There was no significant difference in infection rate between patients with and without neutropenia （ 19.9% , 50/251 vs 20. 3% , 50/251 ; X2 = O. 007, P = O. 933 ）. There was no significant difference in infection rate between patients with and without peginterferon dose reduction （21.5%, 31/144 vs 19.2%, 49/255; X2 = 0.307, P = 0.580）. In multivariate logistic regression analysis, the independent factors associated with infection were age （P = O. 021） , diabetes （P =0. 004） and cirrhosis （P =0. 012）. Conclusions Infections during treatment with peginterferon alfa and ribavirin for chronic hepatitis C are irrelevant to neutropenia. The independent factorsassociated with infection are age, diabetes and cirrhosis.