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目的观察聚乙二醇干扰素α-2a注射液联合利巴韦林治疗脾栓塞术后丙型病毒性肝炎(HCV,丙肝)肝硬化患者的临床疗效和安全性。方法将64例脾栓塞术后丙肝肝硬化患者随机分为对照组32例和试验组32例。2组患者均给予口服利巴韦林片,每次300 mg,tid的治疗。对照组给予皮下注射重组人干扰素α-2b的方式,每次3 MU,隔日注射;试验组在对照组治疗的基础上,给予皮下注射聚乙二醇干扰素α-2a,每次180μg,每周1次。2组患者连续治疗12周。比较2组患者治疗前后HCV RNA阳性率、血常规相关参数,血清谷丙转氨酶(ALT)、谷草转氨酶(AST)水平变化,以及药物不良反应的发生情况。结果治疗前2组患者HCV RNA阳性率均为100%(32/32例),治疗后,试验组和对照组HCV RNA阳性率分别为53.13%(17/32例)和78.12%(25/32例),差异有统计学意义(P<0.05)。治疗后,试验组和对照组的ANC分别为(4.76±0.33)×10~9,(3.92±0.17)×10~9/L;PLT水平分别为(142.73±17.04)×10~9,(128.72±17.96)×10~9/L;WBC水平分别为(8.15±1.84)×10~9,(6.57±1.69)×10~9/L;ALT水平分别为(41.25±22.42),(60.12±21.89)U·L~(-1);AST水平分别为(33.67±18.46),(51.22±16.95)U·L~(-1);AST/ALT值分别为0.78±0.69,1.27±0.73,差异均有统计学意义(均P<0.05)。试验组的药物不良反应发生率为40.63%(13/32例),对照组发生的药物不良反应发生率为28.12%(9/32例),差异无统计学意义(P>0.05)。结论聚乙二醇干扰素α-2a联合利巴韦林治疗脾栓塞术后丙肝肝硬化患者可有效降低患者HCV RNA阳性率,改善患者体内血清AST、ALT水平,安全性高。
Objective To observe the clinical efficacy and safety of peginterferon α-2a injection combined with ribavirin in the treatment of patients with hepatitis C (HCV, hepatitis C) cirrhosis after splenic embolization. Methods Sixty-four patients with hepatitis C cirrhosis after splenic embolization were randomly divided into control group (32 cases) and experimental group (32 cases). 2 groups of patients were given oral ribavirin tablets, each 300 mg, tid treatment. The control group was given subcutaneous injection of recombinant human interferon α-2b, each 3 MU, every other day; the experimental group in the control group on the basis of treatment, given subcutaneous injection of pegylated interferon α-2a, each 180μg, Once a week Two groups of patients for 12 weeks of continuous treatment. The positive rate of HCV RNA, the related parameters of blood, the level of serum ALT and AST, and the incidence of adverse drug reactions were compared between the two groups before and after treatment. Results The positive rates of HCV RNA in the two groups before treatment were 100% (32/32). After treatment, the positive rates of HCV RNA in the two groups were 53.13% (17/32) and 78.12% (25/32 Cases), the difference was statistically significant (P <0.05). After treatment, the ANC of the experimental group and the control group were (4.76 ± 0.33) × 10 ~ 9, (3.92 ± 0.17) × 10 ~ 9 / L respectively; the PLT levels were (142.73 ± 17.04) × 10 ~ ± 17.96) × 10 ~ 9 / L, respectively. The WBC levels were (8.15 ± 1.84) × 10 ~ 9 and (6.57 ± 1.69) × 10 ~ 9 / L, respectively. The ALT levels were (41.25 ± 22.42) and (60.12 ± 21.89 ), AST and ALT were (33.67 ± 18.46) and (51.22 ± 16.95) U · L -1, respectively, and AST / ALT were 0.78 ± 0.69 and 1.27 ± 0.73, respectively There was statistical significance (all P <0.05). The incidence of adverse drug reactions in the experimental group was 40.63% (13/32 cases), and the incidence of adverse drug reactions in the control group was 28.12% (9/32 cases), with no significant difference (P> 0.05). Conclusions Peginterferon alfa-2a combined with ribavirin can effectively reduce the positive rate of HCV RNA in patients with hepatitis C cirrhosis after splenic embolization and improve the level of serum AST and ALT in patients with high safety.