普通干扰素与长效干扰素治疗慢性病毒性肝炎的副作用及其干预

Side effects of common interferon and long-acting interferon in the treatment of chronic viral hepatitis and its interventions

目的在对慢性乙型病毒性肝炎(Chronic hepatitis B,CHB)的治疗中,对聚乙二醇干扰素和普通干扰素的副作用及干预方法等进行研究。方法选择2016年1月-2018年2月温岭市第一人民医院收治的CHB患者90例,随机分为研究组和对照组,每组45例。研究组使用聚乙二醇干扰素治疗,对照组使用普通干扰素治疗,均治疗12个月。干扰素治疗2个月后,两组患者口服升白细胞药物,服用利可君以及维生素B4和鲨肝醇,服用的剂量均为每天三次,均服用至疗程结束。所有患者在干扰素治疗后的第1个月和第2个月,进行抑郁和焦虑评定。采用问卷调查[汉密尔顿抑郁量表(Hamilton depression scale,HAMD),汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)],HAMD和HAMA量表异常的患者服用西酞普兰,于服用西酞普兰后第1月、第2月再次行量表问卷调查。于治疗后第6个月,第12个月测定并比较两组患者的丙氨酸转氧酶(Alanine transaminase,ALT)复常率、HBV-DNA转阴率、乙肝e抗原(Hepatitis B surface antigen,HBeAg)转阴率;于干扰素治疗的2周,第1个月,第2个月,和服升白细胞药物后第1个月,第2个月测定并比较两组患者的白细胞、中性粒细胞、血小板。结果干扰素治疗后第6个月,研究组ALT复常率、HBV-DNA转阴率和HBeAg转阴率分别为71.11%(32/45)、55.56%(25/45)和48.89%(22/45)高于对照组(P<0.05)。干扰素治疗后第12个月,研究组ALT复常率、HBV-DNA转阴率、HBeAg转阴率依然均高于对照组。干扰素治疗后第2个月,两组白细胞、中性粒细胞、血小板均较第1个月降低(P<0.05)。干扰素治疗后1个月,2个月,研究组白细胞、中性粒细胞、血小板均低于对照组(P<0.05)。服用升白细胞药物后第2个月,研究组,对照组的白细胞、中性粒细胞、血小板均较第1个月升高(P<0.05)。服用升白细胞药物后第1个月,第2个月,研究组白细胞、中性粒细胞、血小板均低于对照组(P<0.05)。干扰素治疗后,研究组有25例患者出现了HAMD、HAMA评分异常,对照组有27例患者出现了HAMD、HAMA评分异常,HAMD、HAMA评分均有升高趋势,第2个月评分高于第1个月评分(P<0.05)。干扰素治疗后第1个月,研究组HAMD评分、HAMA评分分别为(22.68±5.12)、(16.27±3.25)分均低于对照组(P<0.05);干扰素治疗后第2个月研究组HAMD、HAMA低于对照组(P<0.05)。服用西酞普兰片治疗后两组HAMD、HAMA评分均有降低趋势,第2个月评分低于第1个月评分(P<0.05);治疗后第1个月、第2个月研究组HAMD、HAMA低于对照组(P<0.05)。结论聚乙二醇干扰素和普通干扰素都易造成骨髓抑制、抑郁、焦虑等精神症状的不良反应,聚乙二醇干扰素比普通干扰素更易造成骨髓抑制。采用有效的临床干预可减少不良反应的发生。

OBJECTIVE To study the side effects and intervention methods of pegylated interferon and common interferon in the treatment of chronic hepatitis B(CHB).METHODS Totally 90 CHB patients admitted to the first people’s Hospital of Wenling City from Jan.2016 to Feb.2018,were randomly divided into study group and control group,with 45 cases in each group.The study group was treated with pegylated interferon,and the control group was treated with common interferon,both of whom were treated for 12 months.After 2 months of interferon treatment,the patients in the two groups took orally leucocyte-promoting drugs,liconor,vitamin B4 and squatanol,at the doses of three times a day,all of which were taken until the end of the treatment course.All patients were evaluated for depression and anxiety at the first and second months after interferon treatment.Using questionnaire surveys[Hamilton Depression Scale,HAMD,HAMA],patients with abnormal HAMD and HAMA scales took citalopram,and the scale questionnaire survey was conducted again in the first and second months after taking citalopram.The normalization rate of alanine transaminase(ALT),the negative rate of HBV-DNA and the hepatitis B surface antigen were measured and compared between the two groups at the 6 th and 12 th month after treatment.During the 2 weeeks,the first and second months of interferon treatment,and the first and second months after taking the leukocyte ascending drug,the white blood cells,neutrophils and platelets were measured and compared.RESULTS At the 6 th month after interferon treatment,the normalization rates of ALT,the conversion rate of HBV-DNA and HBeAg were 71.11%(32/45),55.56%(25/45)and 48.89%(22/45)respectively(P<0.05).At the 12 th month after interferon treatment,the normalization rate of ALT,the conversion rate of HBV-DNA and HBeAg in the study group were still higher than those in the control group.At the second month after interferon treatment,leukocytes,neutrophils and platelets in both groups decreased significantly compared with the first month(P<0.05).One and two months after interferon treatment,the leukocytes,neutrophils and platelets in the study group were significantly lower than those in the control group(P<0.05).In the second month after taking leukocyte-enhancing drugs,the leukocytes,neutrophils and platelets in the study group and the control group were all increased significantly compared with the first month(P<0.05).In the first and second month after taking leukocyte-enhancing drugs,the leukocytes,neutrophils and platelets in the study group were significantly lower than those in the control group(P<0.05).After interferon treatment,25 patients in the study group had abnormal HAMD and HAMA scores,and 27 patients in the control group had abnormal HAMD and HAMA scores.Both HAMD and HAMA scores increased,and the scores in the second month were significantly higher than those in the first month(P<0.05).In the first month after interferon treatment,the HAMD and HAMA score of the study group were(22.68±5.12)and(16.27±3.25),respectively,significantly lower than those of the control group(P<0.05).In the second month after interferon treatment,HAMD and HAMA in the study group were significantly lower than those in the control group(P<0.05).After taking citalopram tablets,the HAMD and HAMA scores of the two groups decreased,and the scores in the second month were significantly lower than of the scores in the first month(P<0.05).In the first and second months after treatment,HAMD and HAMA of the study group were significantly lower than those of the control group(P<0.05).CONCLUSION Both pegylated interferon and common interferon are prone to cause adverse reactions such as myelosuppression,depression,anxiety and other mental symptoms.Peginterferon is more likely to cause myelosuppression than ordinary interferon.Effective clinical intervention can reduce the incidence of adverse reactions.