聚乙二醇化干扰素联合利巴韦林治疗肝移植后丙型肝炎复发四例

目的 探讨聚乙二醇化干扰素(PEG-IFNα-2a)联合利巴韦林(RIB)方案治疗肝移植后丙型肝炎复发的临床疗效.方法 回顾性分析4例肝移植术后丙型肝炎复发患者的临床资料.4例患者中,术前诊断丙型肝炎合并肝硬化3例,丙型肝炎后肝硬化合并肝细胞肝癌1例,术后均采用他克莫司+霉酚酸酯+皮质激素的三联免疫抑制方案.术后8～12周时,患者均经移植肝组织活检证实丙型肝炎复发.复发后,立即采用PFG-IFNα-2a联合RIB方案进行抗丙型肝炎治疗,连续治疗48周.PEG-IFNα-2a的用量为180μg,皮下注射,每周1次;RIB的用量为1000 mg/d,口服.在治疗期间,检查患者的血常规、肝肾功能、丙型肝炎病毒核糖核酸及移植肝组织活检,观察生化学应答、持续病毒学应答及组织学应答等指标.结果 除1例外,其他患者经治疗后出现持续病毒学应答,移植肝功能均恢复正常,在术后0、48和72周,移植肝组织病理学炎症坏死和纤维化情况改善.1例在术后第7天经组织学证实发生急性排斥反应,给予连续3 d皮质激素冲击治疗后,病情好转.无患者因严重的不良反应而停药或退出治疗.结论 PEG-IFNα-2a联合RIB方案是治疗肝移植后丙型肝炎复发的有效方法,患者的耐受性好,不良反应少.

Treatment of hepatitis C virus recurrence after orthotopic liver transplantation by pegylated interferona-2a in combination with ribavirin

Objective To investigate the effective regimen to treat the hepatitis C virus (HCV) recurrence after orthotopic liver transplantation (OLT). Methods The clinical data of 4 cases of HCV recurrence after OLT were retrospectively analyzed. Of the 4 cases, there were 3 cases of HCV related liver cirrhosis and 1 case of HCV related liver cirrhosis in combination with hepatocellular carcinoma. The immunosuppression regimen as FK506, MMF and corticosteroids was used after OLT. As soon as HCV recurrence was confirmed by liver biopsy during 8 to 12 weeks after OLT, pegylated interferonα-2a (PEG-IFNα-2a) and ribavirin (RIB) were used for 48 weeks. PEG-IFNα-2a was started at a dose of 180 μg per week subcutaneously and RIB at a dose of 1000 mg per day orally, respective-ly. Blood routine, liver and kidney function test, HCV-RNA and transplanted liver biopsy were per-formed when necessary and biochemical response, sustained virologic response and histological re-sponse were tested in due time. Remits All of the 4 cases except for 1 achieved sustained virologic re-sponse and the liver function was as normal as before. The histological activity index was improved significantly for both inflammatory activity and fibrosis according to liver biopsy in 0, 48, 72 week srespectively. Case 4 was given corticosteroids for consecutively 3 days when acute rejection was veri-fied by liver biopsy and the condition improved. None of them stopped treatment or withdrew from them directly. Conclusion The combination of PEG-IFNα-2a and RIB was an effective regimen to treat the HCV recurrence after OLT and the side effects could be overcame easily.