血红蛋白检测在干扰素联合利巴韦林治疗丙型肝炎疗效评估中的作用

Effect of hemoglobin detection on evaluation of curative effect of interferon combined with ribavirin on hepatitis C

目的评价血红蛋白(Hb)浓度检测在评估干扰素联合利巴韦林(RBV)治疗慢性丙型肝炎抗病毒应答中的作用。方法给予入组患者干扰素治疗,500万U/次,3次/周,行皮下注射;RBV按患者体重给药,分为<10.6mg/kg组、10.6～12.9mg/kg组、13～15mg/kg组和≥15mg/kg组。治疗过程中将Hb降低的患者分为4类:Hb下降<3g/dl,且绝对值<10.6g/dl(A类);Hb下降<3g/dl,且绝对值>10.6g/dl(B类);Hb下降>3g/dl,且绝对值>10.6g/dl(C类);Hb下降>3g/dl,且绝对值<10.6g/dl(D类)。结合患者治疗后的病毒学应答予以临床分析。结果本研究入组的44例患者中快速病毒学应答(RVR)者占16%、早期病毒学应答(EVR)者占50%、治疗结束时病毒学应答(ETR)者占68%、持续病毒学应答(SVR)者占60%。RBV治疗剂量≥13mg/kg组与<13mg/kg组患者相比,RVR者所占比例(18.5%vs11.7%)差异无统计学意义(P>0.05);但EVR(70.4%vs17.6%)、ETR(80.7%vs46.7%)和SVR(77.3%vs30.7%)者所占比例差异均具有统计学意义(P<0.05)。Hb水平下降但绝对值>10.6g/d患者(B+C类患者)与<10.6g/dl(A+D类患者)相比,RVR(20.7%vs7.1%)、EVR(65.5%vs20%)、ETR(79.3%vs33.3%)和SVR(72%vs30%)患者比例差异均具有统计学意义(P<0.05)。A类患者中ETR(93.3%)和SVR(83.3%)者均较其他三类稍高,但差异无统计学意义。RBV剂量与Hb在RVR、ETR、SVR患者中均呈负相关(P<0.05),且以RVR患者中尤为显著(P<0.01)。结论 Hb浓度可反映RBV治疗的合适剂量,当Hb下降且绝对值>10.6g/dl,RBV治疗剂量为13～15mg/kg者抗病毒效果最佳。

Objective To investigate the role of hemoglobin concentration （Hb） detection in the antiviral response evaluation of interferon combined with ribavirin （RBV） on chronic hepatitis C. Methods Interferon of per 5 million units was injected subcutaneously for the patients, three times a week. RBV were administered according to the patients＇body weight, and the patients were divided into four groups： 〈 10.6 mg/kg, 10.6-12, 9 mg/kg, 13-15mg/kg and t〉15 mg/kg groups. According to the levels of Hb, total of 44 patients were divided into four category ： Hb deereased 〉 3 g/dl with absolute value 〉 10.6 g/dl （ category A）, Hb decreased 〈3 g/dl with absolute value 〉 10.6 g/dl （category B）, Hb decreased 〈 3 g/dl with absolute value 〈 10.6 g/dl （category C ）, Hb decreased 〉 3 g/dl with absolute value 〈 10.6 g/dl （category D）. Results Among the 44 cases, 16% patients reached rapid viral response （RVR） , 50% reaehed early viral response （EVR） , 68% reached end of treatment viral response （ETR）, 60% reached sustained viral response （SVR）. For RBV treatment dose I〉 13 mg/kg and 〈 13 mg/kg groups, the percentages of patients reaehed RVR （18.5% vs 11.7） had no statistical difference （P 〉 0.05）, which were statistically different among patients reached EVR （70.4% vs 17.6% ） , ETR （80.7% vs 46.7） and SVR （77.3% vs 30.7）. Between patients and Hb levels deereased, but the absolute value 〉 10.6 g/L （B ＋ C categories） with Hb absolute value 〈 10.6g/L （categories A ＋ D）, the ratios of RVR （20.7% vs 7.1%）, EVR （65.5% vs 20%）, ETR （79.3% vs 33.3%） and SVR （72% vs 30%） were all with significant differences. The ratios of ETR and SVR in patients of categori A were 93.3% and 83.3% , respectively, which were higher than those of the other three categories but the difference was not statistically significant. RBV dose was correlated negatively with Hb in patients with RVR （P 〈 0.01 ）, ETR and SVR （P 〈 0.05 ）. Conclusions The concentration of Hb could reflect the appropriate RBV dose. Antiviral response was the best when RBV dose was at 13-15 mg/kg and Hb Level decreased but the absolute value 〉 10.6 g/dl.