利巴韦林联合聚乙二醇干扰素α治疗慢性丙型肝炎发生相关溶血性贫血的影响因素分析

徐金凤; 张晓慧; 柳雅立; 张晶

doi:10.3969/j.issn.1001-5256.2019.02.015

利巴韦林联合聚乙二醇干扰素α治疗慢性丙型肝炎发生相关溶血性贫血的影响因素分析

DOI: 10.3969/j.issn.1001-5256.2019.02.015

首都医科大学附属北京佑安医院丙肝与中毒性肝病科

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中图分类号: R512.63
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出版历程
- 出版日期: 2019-02-20

Influencing factors for hemolytic anemia in patients with chronic hepatitis C treated by ribavirin combined with pegylated interferon-α

Department of Hepatitis C & Toxic Liver Diseases, Beijing YouAn Hospital, Capital Medical University

摘要

摘要:
目的本研究利用干扰素队列探讨慢性丙型肝炎治疗过程中利巴韦林（RBV）引起溶血性贫血的影响因素,为临床早期预测RBV相关溶血性贫血发生提供借鉴。方法选取2016年3月-2018年3月于北京佑安医院门诊及住院的慢性丙型肝炎且应用PEG-IFNα联合RBV方案抗病毒治疗患者235例,并在抗病毒治疗前进行血常规、肝功能、肝脏硬度值、HCV RNA、HCV病毒基因型及三磷酸肌苷焦磷酸酶（ITPA）基因型检测,在2、4、8、12周对患者进行血常规检测。符合正态分布的计量资料组间比较采用t检验,不符合正态分布的计量资料组间比较采用Mann-Whitney U检验;计数资料组间比较采用X2检验或Fisher确切概率法。RBV相关溶血性贫血发生的影响因素采用单因素和多因素logistic回归分析,并据此建立预测模型,采用受试者工作特征曲线分析该模型对RBV相关溶血性贫血的预测价值。结果 2、4、8、12周时ITPA（rs1127354）基因型CC组Hb下降程度显著大于AA+AC组（P值均<0.>30 g/L比例（2. 3...
- 肝炎,丙型,慢性 /
- 贫血,溶血性 /
- 利巴韦林 /
- 危险因素
Abstract:
Objective To investigate the influencing factors for ribavirin ( RBV) -induced hemolytic anemia during the treatment of chronic hepatitis C using RBV combined with pegylated interferon-α ( PEG-IFNα) , and to provide a reference for early prediction of RBV-related hemolytic anemia in clinical practice. Methods A total of 235 patients with chronic hepatitis C who were given antiviral therapy with PEG-IFNα combined with RBV in Beijing YouAn Hospital from March 2016 to March 2018 were enrolled. Parameters of routine blood test, liver function parameters, liver stiffness measurement, HCV RNA, HCV viral genotype, and inosine triphosphate pyrophosphatase ( ITPA) genotype were determined before the antiviral therapy, and routine blood tests were performed at weeks 2, 4, 8, and 12 of treatment. The t-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for non-normally distributed continuous data between groups; the chi-square test or the Fisher's exact test was used for comparison of categorical data between groups. Univariate analysis and multivariate logistic regression analyses were used to determine the influencing factors for RBV-related hemolytic anemia, and a predictive model was established accordingly; the receiver operating characteristic curve was used to analyze the predictive value of this model for RBV-related hemolytic anemia. Results At weeks 2, 4, 8, and 12 of treatment, the ITPA ( rs1127354) genotype CC group had a significantly greater reduction in hemoglobin ( Hb) than the ITPA ( rs1127354) genotype AA + AC group ( all P < 0. 05) . At week 4 of treatment, there was a significant difference between the AA + AC group and the CC group in the proportion of patients with a > 30 g/L reduction in Hb ( 2. 38% vs 39. 9%, X2= 23. 175, P < 0. 001) or an Hb level of < 100 g/L ( 0 vs10. 88%, P = 0. 018) . The degree of reduction in Hb at week 2 ( odds ratio ( OR) = 1. 073, P < 0. 001) , ITPA ( rs1127354) genotype ( OR = 18. 920, P = 0. 005) , and baseline Hb level ( OR = 1. 032, P = 0. 024) were independent risk factors for a > 30 g/L reduction in Hb at week 4. Conclusion Patients with ITPA ( rs1127354) genotype CC tend to develop RBV-related hemolytic anemia. ITPA ( rs1127354) genotype, baseline Hb level, and degree of reduction in Hb at week 2 can be used to predict the development of RBV-related hemolysis during anti-HCV treatment, in order to achieve early warning and guide early intervention.
- hepatitis C, chronic /
- anemia, hemolytic /
- ribavirin /
- risk factors

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参考文献(14)

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