由於在醫院時,照顧過一個洗腎患者,他接受C型肝炎治療時,體力變的非常虛弱,主要是因為貧血變更厲害的關係,所以那幾個月患者很辛苦,不過,他是將整個療程完成了,撐了過去,但是我對於患者變的很虛弱這件事情印象深刻,我想讓自己對於這個治療了解的更深入,所以找了一下文獻。有篇研究整理的不錯:
一般人慢性C型肝炎的治療
是使用兩種藥物合併使用,一種抗病毒藥物(Ribavirin),一種是干擾素,兩種同時使用效果較只用一種好的多,但是抗病毒藥物(Ribavirin)是經由腎臟排出的,因此,在腎臟功能不好的患者(eGFR<50 ml/min),抗病毒藥物(Ribavirin)大多建議不能使用,只能單用干擾素。(劑量為subcutaneous weekly doses of 1 g/kg of peginterferon alpha-2b and of 135 ug of peginterferon alpha-2a)
用在洗腎患者身上的效果如何?副作用如何?
干擾素有傳統型與長效型(pegylated),研究指出,兩者的治療反應差不多,治療成功率(sustained virological response)都是4成左右。值得一提的是,40歲以下的患者,治療成功率會顯著提升。
我最想知道的副作用呢?有高達41%的患者,會出現“類流感症狀”,而這些患者中,有11%會因此而中斷治療。常見的副作用包含:疲倦、無力、食慾下降,進而導致體重減輕,如果乾體重沒有適時調整,容易出現水太多的症狀。貧血也十分常見,需要增加EPO(紅血球生成素)的劑量,來因應貧血的惡化。全部接受治療的患者當中,無法完成治療的比例為26-28%,表示每四個接受干擾素治療的洗腎患者中,會有一個無法完成全程治療。
如果是新感染的C型肝炎呢?
一般人的建議是,可觀察8-12周,看是否會自己痊癒。而洗腎患者呢?在台大的劉振驊醫師與高嘉宏教授的研究裡,35個新感染C型肝炎的洗腎患者,觀察16週之後沒有痊癒者,給予長效干擾素(peginterferon alpha 2a,每週135u g,總共24周),治療成功率高達88%,只有兩個患者分別在第8週和第10週中止治療(因為變的太虛弱以及拉肚子,停藥之後都好轉了),另外有7個患者需要把干擾素減量,總計,超過8成患者都能夠完成原訂的療程。
把研究中副作用的比例,整理如下,按照比例高低排列,因篇幅之故,小於10%未列入:
可能的副作用 | 百分比(%) |
疲勞 | 48.6 |
食慾降低 | 34 |
失眠 | 28.6 |
皮疹(dermatitis) | 25.7 |
肌肉酸痛 | 17.1 |
頭痛 | 14.3 |
貧血 | 14.3 |
掉髮 | 14.3 |
發燒、發寒、嘔吐、注射處皮膚反應 | 11.4 |
因為洗腎患者的狀況較為複雜,因此任何治療都需要考慮自身狀況,一定要和醫師充分討論之後,再做決定。
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1.
Liu CH, Liang CC, Liu CJ, et al. Pegylated Interferon Alfa-2a Monotherapy for Hemodialysis Patients with Acute Hepatitis C.
Clin Infect Dis. 2010;51(5):541-549.
http://doi.org/10.1086/655682 1.
Weclawiak H, Kamar N, Ould-Mohamed A, Cardeau-Desangles I, Izopet J, Rostaing L. Treatment of Chronic Hepatitis C Virus Infection in Dialysis Patients: An Update.
Hepatitis Research and Treatment. 2010;2010:e267412.
http://doi.org/10.1155/2010/267412