| Summary: | 碩士 === 中山醫學大學 === 醫學研究所 === 100 === Background：
The World Health Organization estimates that 3% of world’s population is infected with the Hepatitis C virus（HCV）and there are 300,000 people with HCV infection in Taiwan. The current standard of therapy is a combination of pegylated interferon and ribavirin（RBV）. Sustained virologic response（SVR）rates is 40%~52% for genotype 1,and 70%~85%for genotype 2 or 3. Since October 2003, the Bureau of National Health Insurance in Taiwan enforced Hepatitis C trial treatment program and reimburse for the combination therapy. The treatment effect of chronic hepatitis C(HCV) is often limited due to the adverse effects of interferon and ribavirin. Hemolytic anemia and hematological adverse effect may influence the treatment program.
Objective：
The major purpose of this study is to investigate the types of t the Efficacy and Hematologic Effects during the treatment of hepatitis C, using Pegylated interferon alpha-2a or alpha-2b in combination with Ribavirin. By the analysis of its related risk factors, we may understand how to improve the drug safety and lower the expenses of medical resources.
Methods：
Patients who participated in Enforcing Hepatitis C Trial Treatment Program of Bureau of National Health Insurance and received Pegylated interferon and Ribavirin in Chung-Shan Medical University Hospital Between November 2009 and December 2010 were enrolled in this retrospective study. The study was to collect data and laboratory values of the patients from medical chart review
Results：
This study contains 114 patients who chronic hepatitis C virus genotype 1 to accept the integrity of Peginterferon and Ribavirin combination therapy. Treatment to 12 weeks in all patients, according to the periodic inspection of the results of hematology data, WBC and Hb, Platelet has decreased. Average decrease in WBC is 2594.9 ± 1399.7cell/L, the rate of decline an average of 44%; Average decrease in Hb is3.6 ± 1.6 g/dL, the average rate of decline of 24.55%; Average decrease in Platelet is 36.9 ± 47.2x103/mm3, the average rate of decline of 21.88%.The hematology data at the end of the six months is return to the non-treatment area before. The outcome of the treatment, 75 patients achieved the SVR, and 39 patients did not reach SVR, the results of treatment of 65.79%. Erythropoietin efficacy evaluation, Significant differences in the age between the three groups(Group A-62.9±9.3 years、Group B-59.2±8.9 years、Group C-51.9±10.5 years，P＜0.001).In Hemoglobin(Hb), the use of erythropoietic factors significantly less than the other two groups(Group A- 13.6±1.4 g/dL、Group B- 14.±1.4 g/dL、Group C- 15.3.±1.4 g/dL， P＜0.001). The Ribavirin average starting dose (mg / kg / day), Group A are significantly smaller than the other two groups(Group A- 13.6±2.0、Group B- 15.8±2.0、Group C- 14.1±1.8，P＜0.001). The outcome of the treatment, rapid virological response (RVR) and sustained virological response (SVR) is not Significant differences in the three groups.
Conclusions：
The clinical benefits of erythropoietin intervention is confirmed. Lower dose of EPO can increase Hb levels to alleviate HCV combination therapy-induced anemia. The studies suggest that greater care must be given to the patients to advoid adverse events when their laboratory values of hematologic are abnormal.As a consequence, we may lower the medical expenses and improve life quality for those patients.
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