Anemia and thrombocytosis induced by ribavirin monotherapy in patients with chronic hepatitis C.
Anemia and thrombocytosis induced by ribavirin monotherapy in patients with chronic hepatitis C.
复制标题
慢性丙型肝炎患者利巴韦林单药治疗引起的贫血和血小板增多。
DOI：
10.1007/s00535-012-0579-y
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发表时间：
2012
期刊：
影响因子：
6.3
通讯作者：
et al.
中科院分区：
文献类型：
--
作者：
Kobayashi T;Hige s;Sakamoto N;et al.
背景肌苷三磷酸酶（ITPA）单核苷酸多态性（SNP）与慢性丙型肝炎（CHC）患者聚乙二醇化干扰素和利巴韦林（RBV）联合治疗引起的贫血相关。然而，关于 RBV 单药治疗的血液学影响的报道很少。在此，我们对接受 RBV 单药治疗的 CHC 患者的血液学变化进行了监测，并研究了这些变化的机制。方法 CHC 患者 (n = 30) 接受 RBV 单药治疗 4 周。 RBV 剂量根据体重确定。评估全血细胞计数、血清促红细胞生成素（EPO）和血小板生成素（TPO）水平。分析这些参数与 ITPASNP (rs1127354) 之间的关联。 结果 4 周内，所有患者的中位血红蛋白水平显着下降，从 13.6 (10.5–16.6) g/dl 降至 11.7 (9.4–14.9) g/dl (P< 0.001)，血小板计数增加，从14.0×104(8.9–37.4×104)至15.8×104(10.2–40.6×104)/mm3(P=0.003)。第 4 周时，ITPACC 基因型患者与 AA 或 AC 基因型患者之间的血红蛋白水平存在差异 [11.1 (9.4–13.5) vs. 12.9 (12.5–14.9) g/dl，P= 0.001]。贫血患者的血小板变化率（即第 4 周血小板计数/基线血小板计数）与 4 周内血清 EPO 水平升高相关（r= 0.88，P= 0.002），但与 4 周内血清 TPO 水平升高无关。 结论 RBV 单一治疗会导致 CHC 患者贫血并影响血小板增多。内源性 EPO 升高可能会刺激血小板生成。
BackgroundAn inosine triphosphatase (ITPA) single-nucleotide polymorphism (SNP) is associated with anemia induced by pegylated interferon and ribavirin (RBV) combination therapy in patients with chronic hepatitis C (CHC). However, there are very few reports on the hematological effects of RBV monotherapy. Here, hematological changes were monitored in patients with CHC who received RBV monotherapy, and the mechanism of these changes was investigated.MethodsPatients with CHC (n= 30) received RBV monotherapy for 4 weeks. The RBV dose was determined on the basis of body weight. Complete blood count, and serum erythropoietin (EPO) and thrombopoietin (TPO) levels were assessed. The associations between these parameters and theITPASNP (rs1127354) were analyzed.ResultsOver the 4 weeks, the median hemoglobin level of all patients decreased significantly, from 13.6 (10.5–16.6) to 11.7 (9.4–14.9) g/dl (P< 0.001), and the platelet counts increased, from 14.0 × 104(8.9–37.4 × 104) to 15.8 × 104(10.2–40.6 × 104) /mm3(P= 0.003). At week 4, hemoglobin levels differed between patients with theITPACC genotype and those with the AA or AC genotypes [11.1 (9.4–13.5) vs. 12.9 (12.5–14.9) g/dl,P= 0.001]. The platelet change ratio (i.e., platelet count at week 4/platelet count at baseline) in the patients with developing anemia was correlated with the increase in the serum EPO level over 4 weeks (r= 0.88,P= 0.002), but not with the increase in the serum TPO level over 4 weeks.ConclusionsRBV monotherapy induced anemia and affected thrombocytosis in patients with CHC. Elevated endogenous EPO may stimulate platelet production.