长效干扰素联合利巴韦林治疗慢性丙型肝炎患者疗效及其对静息能量消耗和营养状态的影响*

doi:10.3969/j.issn.1672-5069.2021.06.012

摘要/Abstract

摘要： 目的探讨应用长效α-干扰素联合利巴韦林治疗慢性丙型肝炎(CHC)患者疗效及静息能量消耗和营养状态的变化。方法 2017年4月～2019年4月我院收治的CHC患者48例,采用随机数字表法分为观察组24例和对照组24例,分别给予聚乙二醇干扰素α-2a(peg-IFNα-2a)和利巴韦林治疗或干扰素α-2a(IFNα-2a)联合利巴韦林治疗48 w。测量静息能量消耗(REE)和预测静息能量消耗(pREE),常规检测血清前白蛋白(PA)和白蛋白(ALB)水平,计算体质指数(BMI)。结果在治疗48 w结束和随访6 m时,观察组完全应答率分别为62.5%和54.2%,显著高于对照组的37.5%和29.2%,差异有统计学意义(P＜0.05);在观察组,用药前REE和pREE分别为(1504.6±481.5)kcal/d和(1432.3±229.3)kcal/d,在治疗结束时显著增加至(1822.1±546.7)kcal/d和(1241.8±208.6)kcal/d,对照组用药前REE和pREE分别为(1505.2±482.1)kcal/d和(1433.5±231.2)kcal/d,在治疗结束时,显著增加至(1824.4±547.6)kcal/d和(1243.1±208.8)kcal/d, 但两组之间REE和pREE变化无显著性差异(P>0.05);治疗前,观察组BMI及血清PA和ALB水平分别为(19.2±2.0)kg/m²、(161.5±45.2)mg/L和(38.4±4.2)g/L,在治疗结束时分别降为(17.1±1.5)kg/m²、(135.8±40.2)mg/L和(34.2±3.2)g/L,治疗前对照组BMI及血清PA和ALB水平分别为(19.3±2.1)kg/m²、(161.3±45.0)mg/L和(38.5±4.4)g/L,在治疗结束时分别降为(17.2±1.5)kg/m²、(136.3±40.2)mg/L和(34.2±3.1)g/L,但两组之间这些指标的变化无显著性差异(P>0.05)。结论相对于IFNα-2a与利巴韦林联合,应用peg-IFNα-2a与利巴韦林联合治疗CHC患者能够获得更好的治疗效果,但无论何种治疗方案,均增加了能量消耗,降低了体质量和血清白蛋白水平,提示标准方案抗病毒治疗的不良反应还是值得重视的。

关键词: 慢性丙型肝炎, 聚乙二醇干扰素α-2a, 利巴韦林, 静息能量消耗, 治疗

Abstract: Objective The aim of this clinical trial was to investigate the response of peginterferon-α-2a (PEG-IFNα-2a)and ribavirin combination in treatment of patients with chronic hepatitis C and its impact on resting energy expenditure (REE) and nutritional status. Methods Forty-eight patients with CHC were enrolled in this clinical trial between April 2017 and April 2019, and were randomly divided into observation and control group, with 24 cases in each group. The patients in the observation group were treated with PEG-IFNα-2a and ribavirin, and those in the control group were treated with interferon α-2a (IFNα-2a) and ribavirin combination for 48 weeks. The REE, predicted REE (pREE) as well as body mass index (BMI) and serum prealbumin (PA) and albumin (ALB) levels were obtained. Results At the end of 48 week treatment and 6 month of followed-up, the complete response in the observation group were 62.5% and 54.2%, both significantly higher than 37.5% and 29.2% in the control (P＜0.05); at presentation, the REE and pREE in the observation were (1504.6±481.5)kcal/d and (1432.3±229.3)kcal/d, both increased to (1822.1±546.7)kcal/d and (1241.8±208.6)kcal/d at the end of the treatment, and they were (1505.2±482.1)kcal/d and (1433.5±231.2)kcal/d in the control before treatment, and they also increased to (1824.4±547.6)kcal/d and (1243.1±208.8)kcal/d at the end of the regimen, not significantly different between the two groups (P>0.05); before treatment, the BMI, serum PA and ALB levels in the observation were (19.2±2.0)kg/m², (161.5±45.2)mg/L and (38.4±4.2)g/L, they decreased to (17.1±1.5)kg/m², (135.8±40.2)mg/L and (34.2±3.2)g/L at the end of the treatment, and those in the control before treatment were (19.3±2.1)kg/m², (161.3±45.0)mg/L and (38.5±4.4)g/L, and all decreased to (17.2±1.5)kg/m², (136.3±40.2)mg/L and (34.2±3.1)g/L at the end of the treatment, without significant differences between the two groups (P>0.05). Conclusion Compared with IFNα-2a and ribavirin combination, the application of PEG-IFNα-2a and ribavirin in treatment of patients with CHC could achieve a better virological response, while no matter IFNα-2a or PEG-IFNα-2a might increase resting energy expenditure and induce malnutrition, which warrants clinical attentions.

Key words: Chronic hepatitis C, Peginterferon-α-2a, Ribavirin, Resting energy expenditure, Therapy

姜浩, 张雯, 陈霞. 长效干扰素联合利巴韦林治疗慢性丙型肝炎患者疗效及其对静息能量消耗和营养状态的影响^*[J]. 实用肝脏病杂志, 2021, 24(6): 815-818.

Jiang Hao, Zhang Wen, Chen Xia. Peginterferon-α and ribavirin combination in treatment of patients with chronic hepatitis C and its impact on resting energy expenditure and nutritional status[J]. Journal of Practical Hepatology, 2021, 24(6): 815-818.

参考文献

[1] Collier J D, Adams P A, Feinman V, et al. Long-term follow-up of patients with chronic hepatitis C treated with α-interferon. Hepatology, 2016, 15(6):1013-1016.
[2] Schaefer M, Heinz A, Backmund M . Treatment of chronic hepatitis c in patients with drug dependence: time to change the rules? Addiction, 2015, 99(9):1167-1175.
[3] 姚轶男, 黄鹏, 陈红波,等. 江苏省句容市既往有偿献血人群慢性丙型肝炎重度肝纤维化影响因素研究. 中华流行病学杂志, 2017, 38(1):49-52.
[4] Yang S Y, Lee H W, Lee Y J, et al. Highly effective peginterferon α-2a plus ribavirin combination therapy for chronic hepatitis c in hemophilia in Korea. J Hepatol, 2015, 21(2):125-130.
[5] Tahata Y, Hiramatsu N, Oze T, et al. Impact of ribavirin dosage in chronic hepatitis c patients treated with simeprevir, pegylated interferon plus ribavirin combination therapy. J Med Virol, 2016, 88(10):1776-1784.
[6] 中华医学会肝病学分会. 丙型肝炎防治指南(2015年更新版). 中华实验和临床感染病杂志(电子版), 2015, 29(5):1-19.
[7] 冯金周. 亚低温对重型颅脑损伤患者静息能量消耗影响的随机对照研究. 中华神经外科杂志, 2015, 31(31):192-195.
[8] 贾星宇, 华晨, 刘励军,等. 不同方法检测有创机械通气患者静息能量消耗及其意义. 中华内科杂志, 2018, 57(8):596-598.
[9] Mangia A, Andriulli A, Zenarola P, et al. Lack of hepatitis C virus replication intermediate RNA in diseased skin tissue of chronic hepatitis c patients. J Med Virol, 2015, 59(3):277-280.
[10] Foster G R, Irving W L, Cheung M C M, et al. Impact of direct acting antiviral therapy in patients with chronic hepatitis C and decompensated cirrhosis. J Hepatol, 2016, 64(6):1224-1231.
[11] Lee H J, Yeon J E, Yoon E L, et al. Long-term follow-up of chronic hepatitis C patients treated with interferon-alpha: risk of cirrhosis and hepatocellular carcinoma in a single center over 10 years. Intervirology, 2015, 58(1):14-21.
[12] Meng Q H, Hou W, Yu H W, et al. Resting energy expenditure and substrate metabolism in patients with acute-on-chronic hepatitis B liver failure. J Clin Gastroenterol, 2011, 45(5):456-461.
[13] 李剑萍, 陈学福, 严勤,等. 索磷布韦维帕他韦联合或不联合利巴韦林治疗中国成人慢性丙型肝炎病毒感染者的疗效和安全性. 中华肝脏病杂志, 2020, 28(10):831-837.
[14] Lawitz E, Poordad F, Brainard D M, et al. Sofosbuvir with peginterferon-ribavirin for 12 weeks in previously treated patients with hepatitis C genotype 2 or 3 and cirrhosis. Hepatology, 2015, 61(3):769-775.
[15] González-Peralta R P, Liu W Z, Davis G L, et al. Modulation of hepatitis C virus quasispecies heterogeneity by interferon-alpha and ribavirin therapy. J Viral Hepatit, 2015, 4(2):99-106.
[16] Peter J, Nelson D R . Optimal interferon-free therapy in treatment-experienced chronic hepatitis C patients. Liver Int, 2015, 35(1):65-70.
[17] Saleh H, Mohammad I . A bayesian approach for population pharmacokinetic modeling of pegylated interferon α-2a in hepatitis C patients. Clin Pharmacokinet, 2017, 56(11):1369-1379.
[18] Helal G K, Gad M A, Abd-Ellah M F, et al. Hydroxychloroquine augments early virological response to pegylated interferon plus ribavirin in genotype-4 chronic hepatitis C patients. J Med Virol, 2016, 81(12):2170-2178.
[19] Pawlotsky J M, Flisiak R, Sarin S K, et al. Alisporivir plus ribavirin, interferon free or in combination with pegylated interferon, for hepatitis C virus genotype 2 or 3 infection. Hepatology, 2015, 62(4):1013-1023.
[20] Fioravante M, Alegre S M, Marin D M, et al. Weight loss and resting energy expenditure in patients with chronic hepatitis C before and during standard treatment.. Nutrition, 2012, 28(6):630-634.

长效干扰素联合利巴韦林治疗慢性丙型肝炎患者疗效及其对静息能量消耗和营养状态的影响^*

Peginterferon-α and ribavirin combination in treatment of patients with chronic hepatitis C and its impact on resting energy expenditure and nutritional status

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