干擾素α-2b聯(lián)合利巴韋林治療慢性丙型肝炎對外周血細胞的影響
發(fā)布時間：2018-12-12 16:59
【摘要】：目的：總結(jié)干擾素聯(lián)合利巴韋林治療慢性丙型肝炎患者外周血細胞變化的發(fā)生發(fā)展規(guī)律，探討影響外周血細胞改變的相關(guān)因素，闡明外周血細胞變化對SVR率的影響。 方法：入選吉林大學(xué)第一醫(yī)院肝膽胰內(nèi)科2009年~2010年在吉林省扶余縣更新鄉(xiāng)和德勝鎮(zhèn)進行的流行病學(xué)調(diào)查中發(fā)現(xiàn)的慢性丙型肝炎患者343例，給予藥物INF-a2b500萬U、隔日一次、皮下注射，利巴韋林15mg/kg.d口服，療程48周；在基線、2周、12周、24周、36周、48周對患者進行血常規(guī)、HCV RNA定量等檢測，治療結(jié)束60周、72周、96周進行隨訪。出現(xiàn)中性粒細胞減少、貧血及血小板減少的患者依據(jù)《2010丙型肝炎防治指南》進行相應(yīng)治療或隨訪觀察。 結(jié)果： 1.治療過程中中性粒細胞減少癥發(fā)病率為40.5%（139例），貧血發(fā)病率為48.4%（166例），血小板減少癥發(fā)病率為39.9%（137例）。治療結(jié)束后仍有個別患者出現(xiàn)外周血細胞改變�？共《局委熯^程中，外周血細胞減少多出現(xiàn)在治療開始至12周內(nèi)。 2.治療2周內(nèi)中性粒細胞、血紅蛋白、血小板即有明顯下降，至第12周時同時降到最低值，12周后出現(xiàn)緩慢上升，治療結(jié)束時（48周）雖較12周恢復(fù)明顯，但仍未達到治療前水平，60~72周時趨于平穩(wěn)且恢復(fù)到治療前水平。 3.基線中性粒細胞絕對值、血小板計數(shù)、AST、ALT、肝纖維化程度與中性粒細胞減少癥的發(fā)生及嚴重程度相關(guān)，具有統(tǒng)計學(xué)意義（p0.05）。性別與貧血的發(fā)生相關(guān)，基線血紅蛋白水平與貧血的發(fā)生及嚴重程度均相關(guān)，，具有統(tǒng)計學(xué)意義（p0.05）。性別、基線中性粒細胞絕對值、血小板計數(shù)、AST、ALT、r-GT、肝纖維化程度與血小板減少癥的發(fā)生相關(guān)，具有統(tǒng)計學(xué)意義（p0.05）。 4.2周血紅蛋白降幅1.9g/dl、4周血小板計數(shù)降幅5×109/L的患者分別發(fā)生貧血、血小板減少癥的幾率更大（p0.05)。 5.中性粒細胞在任一監(jiān)測點下降幅度與SVR率均不相關(guān)；血紅蛋白4周降幅超過2.9g/dl、血小板4周下降幅度低于11.5×109/L的患者SVR率更高（p0.05)。 結(jié)論： 1.抗病毒治療2周內(nèi)外周血細胞即有明顯下降，12周時降至最低，提醒臨床醫(yī)生及時對患者進行隨訪及干預(yù)，避免嚴重不良事件的發(fā)生。 2.根據(jù)基線性別、外周血細胞水平、肝功、肝纖維化程度可評估抗病毒過程中外周血細胞減少是否發(fā)生及嚴重程度。 3.根據(jù)2周血紅蛋白降幅、4周血小板降幅可提示整體治療過程中貧血、血小板減少癥發(fā)生幾率。 4.4周血紅蛋白、血小板降幅對SVR率具有一定預(yù)測作用。
[Abstract]:Objective: to summarize the changes of peripheral blood cells in patients with chronic hepatitis C treated with interferon and ribavirin, to explore the related factors affecting the changes of peripheral blood cells and to elucidate the effect of changes of peripheral blood cells on the rate of SVR. Methods: from 2009 to 2010, 343 patients with chronic hepatitis C were selected from Department of Hepatobiliary and Pancreatic Medicine of the first Hospital of Jilin University in Huexin Township and Desheng Town, Fuyu County, Jilin Province. The patients were given INF-a2b500 Wan U every other day. Ribavirin 15mg/kg.d was administered subcutaneously for 48 weeks. At baseline, 2 weeks, 12 weeks, 24 weeks, 36 weeks, 48 weeks, the patients were followed up at 60 weeks, 72 weeks and 96 weeks after treatment. Patients with neutropenia, anemia and thrombocytopenia were treated or followed up according to < 2010 guidelines for the prevention and treatment of hepatitis C. Results: 1. The incidence of neutropenia, anemia and thrombocytopenia were 40.5% (139 cases), 48.4% (166 cases) and 39.9% (137 cases). After treatment, some patients still had peripheral blood cell changes. In the course of anti-viral therapy, peripheral blood cell decline occurs within 12 weeks after treatment. 2. Neutrophils, hemoglobin and platelets decreased significantly within 2 weeks of treatment, and reached the lowest level at the 12th week, and increased slowly after 12 weeks, and recovered significantly at the end of the treatment (48 weeks) than at the 12th week. However, it did not reach the pre-treatment level, and at 60 ~ 72 weeks it tended to be stable and recovered to the pre-treatment level. 3. The baseline neutrophil absolute value, platelet count, and the degree of hepatic fibrosis in AST,ALT, were significantly correlated with the occurrence and severity of neutropenia (p0.05). Gender was associated with anemia, and baseline hemoglobin level was correlated with the incidence and severity of anemia (p0.05). Sex, baseline neutrophil absolute value, platelet count, and degree of hepatic fibrosis in AST,ALT,r-GT, were correlated with the occurrence of thrombocytopenia (p0.05). Patients with 4.2 weeks hemoglobin decreased by 1.9 g / dlg / L and platelet count decreased by 5 脳 10 ~ 9 / L at 4 weeks were more likely to develop anemia and thrombocytopenia (p0.05). 5. The decrease of neutrophils at any monitoring point was not related to the SVR rate. The decrease of hemoglobin in 4 weeks was more than 2.9 g / dl, and the decrease of platelet in 4 weeks was lower than 11.5 脳 10 9 / L, the SVR rate was higher (p0.05). Conclusion: 1. The peripheral blood cells decreased significantly within 2 weeks of antiviral therapy and reached the lowest at 12 weeks. The clinicians were reminded to follow up and intervene in time to avoid the occurrence of serious adverse events. 2. According to baseline sex, peripheral blood cell level, liver function, and liver fibrosis degree, we can evaluate the occurrence and severity of peripheral blood cell reduction during antiviral process. 3. According to the reduction of hemoglobin at 2 weeks, the decrease of platelet at 4 weeks may indicate the incidence of anemia and thrombocytopenia during the whole treatment. At 4. 4 weeks, hemoglobin and platelet decrease could predict the SVR rate.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R512.63
本文編號：2374960
[Abstract]:Objective: to summarize the changes of peripheral blood cells in patients with chronic hepatitis C treated with interferon and ribavirin, to explore the related factors affecting the changes of peripheral blood cells and to elucidate the effect of changes of peripheral blood cells on the rate of SVR. Methods: from 2009 to 2010, 343 patients with chronic hepatitis C were selected from Department of Hepatobiliary and Pancreatic Medicine of the first Hospital of Jilin University in Huexin Township and Desheng Town, Fuyu County, Jilin Province. The patients were given INF-a2b500 Wan U every other day. Ribavirin 15mg/kg.d was administered subcutaneously for 48 weeks. At baseline, 2 weeks, 12 weeks, 24 weeks, 36 weeks, 48 weeks, the patients were followed up at 60 weeks, 72 weeks and 96 weeks after treatment. Patients with neutropenia, anemia and thrombocytopenia were treated or followed up according to < 2010 guidelines for the prevention and treatment of hepatitis C. Results: 1. The incidence of neutropenia, anemia and thrombocytopenia were 40.5% (139 cases), 48.4% (166 cases) and 39.9% (137 cases). After treatment, some patients still had peripheral blood cell changes. In the course of anti-viral therapy, peripheral blood cell decline occurs within 12 weeks after treatment. 2. Neutrophils, hemoglobin and platelets decreased significantly within 2 weeks of treatment, and reached the lowest level at the 12th week, and increased slowly after 12 weeks, and recovered significantly at the end of the treatment (48 weeks) than at the 12th week. However, it did not reach the pre-treatment level, and at 60 ~ 72 weeks it tended to be stable and recovered to the pre-treatment level. 3. The baseline neutrophil absolute value, platelet count, and the degree of hepatic fibrosis in AST,ALT, were significantly correlated with the occurrence and severity of neutropenia (p0.05). Gender was associated with anemia, and baseline hemoglobin level was correlated with the incidence and severity of anemia (p0.05). Sex, baseline neutrophil absolute value, platelet count, and degree of hepatic fibrosis in AST,ALT,r-GT, were correlated with the occurrence of thrombocytopenia (p0.05). Patients with 4.2 weeks hemoglobin decreased by 1.9 g / dlg / L and platelet count decreased by 5 脳 10 ~ 9 / L at 4 weeks were more likely to develop anemia and thrombocytopenia (p0.05). 5. The decrease of neutrophils at any monitoring point was not related to the SVR rate. The decrease of hemoglobin in 4 weeks was more than 2.9 g / dl, and the decrease of platelet in 4 weeks was lower than 11.5 脳 10 9 / L, the SVR rate was higher (p0.05). Conclusion: 1. The peripheral blood cells decreased significantly within 2 weeks of antiviral therapy and reached the lowest at 12 weeks. The clinicians were reminded to follow up and intervene in time to avoid the occurrence of serious adverse events. 2. According to baseline sex, peripheral blood cell level, liver function, and liver fibrosis degree, we can evaluate the occurrence and severity of peripheral blood cell reduction during antiviral process. 3. According to the reduction of hemoglobin at 2 weeks, the decrease of platelet at 4 weeks may indicate the incidence of anemia and thrombocytopenia during the whole treatment. At 4. 4 weeks, hemoglobin and platelet decrease could predict the SVR rate.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R512.63
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本文編號：2374960
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