中华内科杂志
中華內科雜誌
중화내과잡지
CHINESE JOURNAL OF INTERNAL MEDICINE
2012年
1期
46-50
,共5页
孙丽杰%于建武%康鹏%赵勇华%颜炳柱
孫麗傑%于建武%康鵬%趙勇華%顏炳柱
손려걸%우건무%강붕%조용화%안병주
肝炎,丙型,慢性%中性粒细胞减少%感染%危险因素
肝炎,丙型,慢性%中性粒細胞減少%感染%危險因素
간염,병형,만성%중성립세포감소%감염%위험인소
Hepatitis C,chronic%Neutropenia%Infection%Risk factors
目的 研究聚乙二醇干扰素(PEG-IFN) α-2a联合利巴韦林治疗慢性丙型肝炎(CHC)期间中性粒细胞(ANC)减少症发生率及其与临床感染发生之间的关系.方法 对哈尔滨医科大学附属第二医院进行PEG-IFNα-2a联合利巴韦林治疗的399例CHC患者进行回顾性分析,研究ANC减少症、临床感染的发生率及其之间的关系,分析影响临床感染发生的危险因素.结果 治疗期间251例患者发生ANC减少症(ANC＜1.50×109/L),占62.9％.其中,轻度ANC减少症[ANC ( ＞0.75～＜1.50) x109/L]132例；中度ANC减少症[ANC(0.50～0.75)x 109/L]103例；重度ANC 减少症( ANC＜0.50×109/L) 16例.399例CHC患者中,80例(20.1％)发生临床感染,其中14例发生重度感染.伴有ANC减少症患者的临床感染发生率为19.9％ (50/251)与未伴有ANC减少症的患者[20.3％ (30/148)]相比,差异无统计学意义(x2 =0.007,P=0.933).调整PEG-IFNα-2a剂量患者的临床感染发生率为21.5％(31/144),与未调整剂量患者[19.2％ (49/255)]相比,差异无统计学意义(x2=0.307,P=0.580).在多因素分析中,年龄(P =0.021)、糖尿病(P =0.004)和肝硬化(P =0.012)是影响CHC患者发生临床感染的独立危险因素.结论 CHC患者抗病毒治疗期间临床感染的发生与ANC减少症无明显关系.年龄、糖尿病和肝硬化是预测CHC患者发生临床感染的危险因素.
目的 研究聚乙二醇榦擾素(PEG-IFN) α-2a聯閤利巴韋林治療慢性丙型肝炎(CHC)期間中性粒細胞(ANC)減少癥髮生率及其與臨床感染髮生之間的關繫.方法 對哈爾濱醫科大學附屬第二醫院進行PEG-IFNα-2a聯閤利巴韋林治療的399例CHC患者進行迴顧性分析,研究ANC減少癥、臨床感染的髮生率及其之間的關繫,分析影響臨床感染髮生的危險因素.結果 治療期間251例患者髮生ANC減少癥(ANC＜1.50×109/L),佔62.9％.其中,輕度ANC減少癥[ANC ( ＞0.75～＜1.50) x109/L]132例；中度ANC減少癥[ANC(0.50～0.75)x 109/L]103例；重度ANC 減少癥( ANC＜0.50×109/L) 16例.399例CHC患者中,80例(20.1％)髮生臨床感染,其中14例髮生重度感染.伴有ANC減少癥患者的臨床感染髮生率為19.9％ (50/251)與未伴有ANC減少癥的患者[20.3％ (30/148)]相比,差異無統計學意義(x2 =0.007,P=0.933).調整PEG-IFNα-2a劑量患者的臨床感染髮生率為21.5％(31/144),與未調整劑量患者[19.2％ (49/255)]相比,差異無統計學意義(x2=0.307,P=0.580).在多因素分析中,年齡(P =0.021)、糖尿病(P =0.004)和肝硬化(P =0.012)是影響CHC患者髮生臨床感染的獨立危險因素.結論 CHC患者抗病毒治療期間臨床感染的髮生與ANC減少癥無明顯關繫.年齡、糖尿病和肝硬化是預測CHC患者髮生臨床感染的危險因素.
목적 연구취을이순간우소(PEG-IFN) α-2a연합리파위림치료만성병형간염(CHC)기간중성립세포(ANC)감소증발생솔급기여림상감염발생지간적관계.방법 대합이빈의과대학부속제이의원진행PEG-IFNα-2a연합리파위림치료적399례CHC환자진행회고성분석,연구ANC감소증、림상감염적발생솔급기지간적관계,분석영향림상감염발생적위험인소.결과 치료기간251례환자발생ANC감소증(ANC＜1.50×109/L),점62.9％.기중,경도ANC감소증[ANC ( ＞0.75～＜1.50) x109/L]132례；중도ANC감소증[ANC(0.50～0.75)x 109/L]103례；중도ANC 감소증( ANC＜0.50×109/L) 16례.399례CHC환자중,80례(20.1％)발생림상감염,기중14례발생중도감염.반유ANC감소증환자적림상감염발생솔위19.9％ (50/251)여미반유ANC감소증적환자[20.3％ (30/148)]상비,차이무통계학의의(x2 =0.007,P=0.933).조정PEG-IFNα-2a제량환자적림상감염발생솔위21.5％(31/144),여미조정제량환자[19.2％ (49/255)]상비,차이무통계학의의(x2=0.307,P=0.580).재다인소분석중,년령(P =0.021)、당뇨병(P =0.004)화간경화(P =0.012)시영향CHC환자발생림상감염적독립위험인소.결론 CHC환자항병독치료기간림상감염적발생여ANC감소증무명현관계.년령、당뇨병화간경화시예측CHC환자발생림상감염적위험인소.
Objective To investigate the corelation between neutropenia (ANC) incidence and infection during treatment with peginterferon alfa and ribavirin for chronic hepatitis C.Methods A retrospective cohort study of 399 patients treated with peginterferon and ribavirin derived from database of Department of Infectious Diseases, the Second Affiliated Hospital, Harbin Medical University was conducted.The incidence of infections and their relation with ANC were investigated.Potential risk factors for infection were identified by multivariate analysis.Results During treatment,neutropenia (ANC ＜ 1.50 ×109/L) occurred in 251 patients.Among which,mild neutropenia [ANC: ( ＞ 0.75-＜ 1.50) x 109/L],moderate neutropenia [ANC: ( 0.50-0.75 ) × 109/L]and severe neutropenia ( ANC ＜ 0.50 × 109/L)occurred in 132 patients,103 patients and 16 patients,respectively.A total of 80 infections (20.1％ )occurred,among which,14 infections were defined as severe.There was no significant difference in infection rate between patients with and without neutropenia ( 19.9％,50/251 vs 20.3％,50/251 ; x2 =0.007,P =0.933).There was no significant difference in infection rate between patients with and without peginterferon dose reduction ( 21.5％,31/144 vs 19.2％,49/255 ; x2 =0.307,P =0.580 ).In multivariate logistic regression analysis,the independent factors associated with infection were age (P =0.021),diabetes (P =0.004) and cirrhosis (P =0.012).Conclusions Infections during treatment with peginterferon alfa and ribavirin for chronic hepatitis C are irrelevant to neutropenia.The independent factors associated with infection are age,diabetes and cirrhosis.
