慢性丙型肝炎抗病毒治疗期间血红蛋白的变化特点及意义

目的 研究慢性丙型肝炎(CHC)患者抗病毒治疗期间血红蛋白(Hb)的变化、影响因素及其与持续病毒学应答率(SVR)的关系,为贫血的监测及处理提供依据,提高治疗应答率.方法 对214例CHC患者予聚乙二醇干扰素(PEG-IFN)联合利巴韦林(RBV)抗病毒治疗,疗程48周,停药后随访24周.检测治疗前、后及治疗期间血红蛋白(Hb)的变化,以SVR作为疗效的主要评价指标,分析贫血(Hb≤100 g/L)发生的相关因素,探讨Hb变化与SVR的关系,评估Hb检测在治疗应答中的作用.结果 214例患者中,156例(72.9％)Hb下降≥30 g/L,86例(40.2％)出现贫血,26例(12.2％)Hb≤80 g/L.性别(P=0.000)、年龄(P =0.000)、体重(P =0.001)、基线肌酐清除率(P =0.000)、基线白细胞计数(P =0.000)、基线中性粒细胞计数(P=0.019)、基线Hb(P =0.000)及基线血小板计数(P=0.037)均与贫血的发生有关.治疗2周Hb≤120 g/L(P =0.000)或Hb下降≥15 g/L(P=0.000)与治疗2周后的Hb水平有关.治疗期间Hb下降及下降幅度与SVR无关.结论 女性、年龄大、体重轻、肌酐清除率低及基线白细胞计数、中性粒细胞计数、Hb、血小板水平低者是贫血发生的高危因素;治疗2周时的Hb水平可以预测2周后的Hb水平;Hb的变化不可预测抗病毒疗效.

Hemoglobin concentration decline and its relationship with responses to therapy in patients with chronic hepatitis C

Objective To investigate the variety of hemoglobin concentration (Hb) and the decline of Hb on the responses to therapy in patients with chronic hepatitis C (CHC).Methods A total of 214 patients with CHC were prospectively treated with pegylated interferon α (PEG-IFN α) in combination with ribavirin (RBV) for 48 weeks.After finishing the therapy,the patients were followed up for 24 weeks and the therapeutic effect was evaluated with sustained virological response (SVR).Hb was tested at baseline,during the treatment and after the therapy.The factors affecting the Hb decline and the effect of Hb decline on responses to therapy were assessed.Results Hb decline (decline ≥ 30 g/L) was observed in 156 (72.9％) patients,anemia (Hb≤100 g/L) occurred in 86 (40.2％) patients,and Hb≤80 g/L occurred in 26 (12.2％) patients.Sex (P =0.000),age (P =0.000),weight (P =0.00),baseline creatinine clearance (P =0.000),baseline leukocyte count (P =0.000),baseline neutrophil count (P =0.019),baseline Hb (P =0.000) and baseline platelet count (P =0.037) were significantly associated with anemia.Hb ≤ 120 g/L (P =0.000) or a rapid decline in Hb of ≥30 g/L at Week 2 (P =0.000)was also significantly associated with the decline of Hb after Week 2.Neither Hb ≤100 g/L (P =1.000) nor Hb decline ≥30 g/L (P =0.646) during treatment was associated with SVR.Conclusion Several baseline factors,including female,older age,lower weight,lower creatinine clearance,and lower blood cells count are predictive of developing anemia.Hb decline at Week 2 is an important predictor for the Hb decline after that.And we could not predict SVR by testing Hb during treatment.