Assessment of Factors Correlated with Ribavirin Dose Reduction Due to Hemolytic Anemia during Treatment in Patients with Chronic Hepatitis C Treated with Pegylated Interferon and Ribavirin Combination Therapy

以長效型干擾素合併雷巴威林治療慢性C型肝炎成功預測分析及治療期間因溶血性貧血而需減低雷巴威林治療劑量之相關因素分析

文士祺(Shi-Chi Wen) ； 鄭隆致(Lung-Chih Cheng) ； 徐瑞宏(Jui-Hung Hsu) ； 史珮甄(Pei-Chen Shih) ； 蔡奇璋(Chi-Chang Tsai) ； 郭武憲(Wu-Hsien Kuo)

《寶建醫護與管理雜誌》 13卷1&2期 (2016/06) Pp. 1-8

https://doi.org/10.29681/PCJHM.201606_13(1_2).0002

摘要

Backgrounds: Chronic hepatitis C (HCV) is a major public health problem leading to cirrhosis and hepatocecullar carcinoma. Pegylated interferon-α (PEG-IFN) plus ribavirin (RBV) combination therapy (PR) has become a standard of care (SOC) treatment for HCV in Taiwan in the past ten years. Hemolytic anemia is a common side effect of RBV. Aims: This study aimed to evaluate those factors that contributed to the reduction in RBV dose due to hemolytic anemia. Methods: Retrospective study was conducted. A total of 158 HCV patients with PR combination therapy in accordance with response guide therapy were consecutively enrolled between Jan 2010 and Jun 2014. The baseline factors for RBV dose reduction were computed by using univariate and multivariate logistic regression analysis.Results: On univariate analysis, RBV dose reduction correlated with Hb levels equal or lower (≦) 14g/dl, female, age beyond (＞)55 years, cirrhosis, and not moderate-severe fatty liver. On multivariate analysis, factors contributing to RBV dose reduction were Hb levels equal or lower (≦) 14g/dl (OR=5.108, 95% CI: 2.233-11.683, P=0.000), and cirrhosis (OR=2.706, 95% CI: 1.065-6.877, P=0.036). Conclusions: Hb levels≦14 g/dl and cirrhosis are independent predictors contributing to RBV dose reduction. More careful monitoring is necessary during combination therapy.

關鍵字

Chronic hepatitis C infection ； PEG-interferon ribavirin combination therapy ； anemia

並列摘要

背景：成功治療慢性C型肝炎在肝癌、肝硬化防治是一大突破。依病毒反應為指引 (RGT)，以長效型干擾素(PEG-IFN)為基礎加口服雷巴威林(RBV) 療法(PR)，在過去十年已成為國內治療慢性C型肝炎的標準方式(SOC)。但因服用雷巴威林產生溶血性貧血，將影響病患的治療意願及最後效果。關於影響治療預後及因副作用而需減低治療劑量的相關因素探討，國內報告仍然有限。目的：探討以PR合併療法治療慢性C型肝炎，因服用RBV衍生嚴重貧血而需減量之相關因素分析。 方法：以回朔性研究方式， 收集自2010年1月至2014年6月期間慢性C型肝炎病患，在本院接受PR療法共158例，依病毒反應為指引 (RGT) 治療 24-48週，以多變項邏輯回歸統計方法分析相關基本因素，決定影響RBV減量的獨立預測因素。結果：單變項因素分析顯示，病患血色素小於14gm/dl，女性，年紀大於55歲，非中重度脂肪肝及肝硬化有密切關連性。多變項因素分析顯示，血色素小於14gm/dl(OR=5.108, 95% CI: 2.233-11.683, P=0.000) 與肝硬化(OR=2.706, 95% CI: 1.065-6.877, P=0.036)是決定RBV減量的獨立預測因素。結論：血色素小於14gm/dl及肝硬化因素容易影響並造成溶血性貧血的產生，PR合併治療時，臨床宜小心監測並適時減低RBV治療劑量，以避免併發症產生。

並列關鍵字

C型肝炎 ； 干擾素合併雷巴威林治療 ； 溶血性貧血