A randomized study comparing ribavirin and interferon alfa monotherapy for hepatitis C recurrence after liver transplantation
A randomized study comparing ribavirin and interferon alfa monotherapy for hepatitis C recurrence after liver transplantation
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一项比较利巴韦林和干扰素α单药治疗肝移植后丙型肝炎复发的随机研究
作者：
E. Gane;S. Lo;S. Riordan;B. Portmann;J. Lau;N. Naoumov;Roger Williams
丙型肝炎病毒（HCV）感染通常在原位肝移植（OLT）后复发，并且大多数患者会出现移植物损伤。本研究比较了干扰素α (IFN-α) 和利巴韦林单一疗法对移植物中患有慢性丙型肝炎的肝移植受者的疗效。 30 名患有慢性丙型肝炎的 OLT 接受者被随机接受 IFN-α（每周 3 次 3 MU）或利巴韦林（每天最多 1.2 g）治疗，持续 24 周。评估了对治疗的病毒学、生化和组织学反应。 28 名患者完成了治疗方案，两名接受利巴韦林治疗的患者因严重溶血而退出。接受利巴韦林治疗的 14 名患者中有 13 名 (93%) 实现了血清天冬氨酸转氨酶正常化，接受 IFN-α 治疗的 14 名患者中有 6 名 (43%；P = .01) 实现了血清天冬氨酸转氨酶正常化。 9/14 名利巴韦林治疗患者 (64%) 和 14 名 IFN-α 治疗患者中有 3 名 (21%; P = .05) 患者的小叶炎症有所减轻，他们均出现了生化反应。然而，干扰素组 (P = .43) 或利巴韦林组 (P = .96) 的总组织学活性指数均未改善。接受 IFN-α 治疗的患者的治疗后病毒血症水平显着降低（P = .05），但接受利巴韦林治疗的患者则没有显着降低（P = .88）。所有接受利巴韦林治疗的患者均发生溶血，50% 的患者血清血红蛋白降至 <10 g/dL。利巴韦林治疗期间，白细胞和淋巴细胞总数显着下降（分别为 P = .02 和 P = .004）。我们的结论是，在 OLT 后的慢性丙型肝炎患者中，IFN-α 保留了抗病毒作用，而利巴韦林在实现血清天冬氨酸转氨酶水平正常化和减少小叶炎症方面更胜一筹，但在总组织学活动指数方面则不然。这些发现为 OLT 后联合治疗提供了理论依据，尽管必须仔细监测患者的溶血情况。
Hepatitis C virus (HCV) infection usually recurs after orthotopic liver transplantation (OLT), and most patients develop graft damage. This study compared the efficacy of interferon alfa (IFN‐α) and ribavirin monotherapies in liver transplant recipients with chronic hepatitis C in the graft. Thirty OLT recipients with chronic hepatitis C were randomized to receive either IFN‐α (3 MU three times a week) or ribavirin (up to 1.2 g daily) for 24 weeks. Virological, biochemical, and histological responses to treatment were assessed. Twenty‐eight patients completed the treatment regimen, two ribavirin‐treated patients being withdrawn because of severe hemolysis. Normalization of serum aspartate aminotransferase was achieved in 13 of 14 patients receiving ribavirin (93%) and 6 of 14 patients receiving IFN‐α (43%; P = .01). Lobular inflammation was reduced in 9/14 ribavirin‐treated (64%) and 3 of 14 IFN‐α–treated patients (21%; P = .05), each of whom had a biochemical response. However, the total histological activity index did not improve in either the interferon (P = .43) or the ribavirin (P = .96) group. Posttreatment viremia levels were significantly reduced in IFN‐α–treated (P = .05) but not in ribavirin‐treated (P = .88) patients. Hemolysis occurred in all ribavirin‐treated patients, with serum hemoglobin decreasing to <10 g/dL in 50%. Total leukocyte and lymphocyte counts decreased significantly during ribavirin treatment (P = .02 and P = .004, respectively). We concluded that in patients with chronic hepatitis C after OLT, IFN‐α retains an antiviral effect whereas ribavirin is superior in achieving normalization of serum aspartate aminotransferase levels and reducing lobular inflammation, but not the total histological activity index. These findings provide a rationale for combination therapy in the post‐OLT setting, although patients must be carefully monitored for hemolysis.
利巴韦林的分子作用机制。
DOI：
10.1093/clinids/12.6.1139
发表时间：
1990
期刊：
Reviews of infectious diseases
影响因子：
--
作者：
Patterson,JL;Fernandez-Larsson,R
通讯作者：
Fernandez-Larsson,R
影响因子：
158.5
作者：
Reuss, ML;Paneth, N;Susser, M
通讯作者：
Susser, M