正確處理派羅欣治療期間的不良反應(yīng)

1、會(huì)計(jì)學(xué)1正確處理派羅欣治療期間的不良反應(yīng)正確處理派羅欣治療期間的不良反應(yīng)不良反應(yīng)處理厭食少吃多餐；在清晨即食欲最好的時(shí)候多吃惡心/嘔吐如果清晨感到惡心，食用餅干或面包；考慮使用止吐藥避免刺激，如烹飪的氣味或油膩食物，以免誘發(fā)惡心腹瀉補(bǔ)充水分，對(duì)癥處理常劑量越大胃腸道癥狀出現(xiàn)越強(qiáng)，但一般無需治療Lotrich FE, et al. Journal of Psychosomatic Research. 2007; 63: 131135.治療期間發(fā)生抑郁的患者治療期間未發(fā)生抑郁的患者M(jìn)arcellin P, et al. Liver International. 2008; 28(4): 477-8

2、5.陸重琳, 等. 南京鐵道醫(yī)學(xué)院學(xué)報(bào). 2000; 19(3): 201-202Jorge R et al. J Clin Oncol, 1986, 4(2): 234-43.中性粒細(xì)胞中性粒細(xì)胞計(jì)數(shù)中位數(shù)計(jì)數(shù)中位數(shù)( (10109 9/ /L)L)時(shí)間時(shí)間(周周)BL 4 8 12 16 20 24 28 32 36 40 44 48 52 56 60 64 68 721.5122.533.50.50派羅欣180 g + 安慰劑 IFN -2b 3 MIU + 利巴韋林派羅欣180 g + 利巴韋林 Fried MW. Hepatology, 2002, S237-S244.27%2%9%

3、63%01020304050607080至少至少1次次1500/mm3患者比例患者比例 (%)至少至少1次次1000/mm3至少至少1次次750/mm3至少至少1次次500/mm3中性粒細(xì)胞計(jì)數(shù)中性粒細(xì)胞計(jì)數(shù)SOZA et al. Hepatology, 2002; 36(5): 1273-9.Doglas T. Dieterich, Jerry L. Spivak.CID 2003:37-533中性粒細(xì)胞計(jì)數(shù)基線：38001700 /mm3 ；低點(diǎn)：19001100 /mm3Cooper et al. Clinical Infectious Diseases, 2006; 42:1674-8

4、.N=192024681216 2024283236404448中性粒細(xì)胞（103/l）4.003.002.001.00治療中并發(fā)感染治療中無并發(fā)感染治療周數(shù)Cooper et al. Clinical Infectious Diseases, 2006; 42:1674-8.中性粒細(xì)胞減少患者中發(fā)生感染比例與中性粒細(xì)胞未減少患者相似012243648治療周數(shù)1.00.80.60.40.20.0未感染的人數(shù)比例N=192OR=1.2;95% CI,0.6-2.4P=0.7中性粒細(xì)胞1000/mm3,中性粒細(xì)胞1000/mm3,派羅欣派羅欣III期臨床試驗(yàn)中期臨床試驗(yàn)中血液學(xué)不良反應(yīng)的處理原則血

5、液學(xué)不良反應(yīng)的處理原則血液參數(shù)派羅欣粒細(xì)胞 750 /L 1000 /L, 繼續(xù)以50%劑量，并監(jiān)測(cè)粒細(xì)胞血小板 75,000 /L 50,000 /L 25,000 /L 降低劑量達(dá)50%停藥 1. Jorge R et al. J Clin Oncol, 1986, 4(2): 234-43.2. Cooper et al. Clinical Infectious Diseases, 2006; 42:1674-8.3. SOZA et al. Hepatology, 2002; 36(5): 1273-9.Jamie C. Mandac,et al. The Clinical and P

6、hysiological Spectrum of Interferon-Alpha Induced Thyroiditis: Toward a New Classification. HEPATOLOGY 2006;43:661-672.病毒性肝炎患者尤其是高危人群，干擾素治療前檢測(cè)TSH和甲狀腺自身抗體(TAb)TSH正常且TAb陰性TSH正常而TAb陽性TSH異常而TAb+/-每三個(gè)月隨訪一次TSH直至干擾素治療結(jié)束干擾素治療結(jié)束時(shí)檢測(cè)TSH和TRAb如出現(xiàn)異常，處理見后每?jī)蓚€(gè)月隨訪一次TSH直至干擾素治療結(jié)束干擾素治療結(jié)束時(shí)檢測(cè)TSH和TRAb如出現(xiàn)異常，處理見后進(jìn)一步明確甲狀腺功能異常

7、的種類處理見后Sato K, et al. Reversible, extremely severe hypothyroidism in a patient with chronic hepatitis C treated with interferon-alpha. Thyroid. 1996 Jun;6(3):249-52. CARLO CARELLA, et al. Long-Term Outcome of Interferon-a-Induced Thyroid Autoimmunity and Prognostic Influence of Thyroid Autoantibody

8、Pattern at the End of Treatment. J Clin Endocrinol Metab 86: 19251929, 2001.甲狀腺功能減退癥患者檢測(cè)甲狀腺自身抗體陰性陽性甲狀腺素短期治療繼續(xù)干擾素治療甲狀腺素長(zhǎng)期治療繼續(xù)干擾素治療破壞性甲狀腺毒癥患者無癥狀有癥狀無需針對(duì)性治療繼續(xù)干擾素治療加用阻滯劑治療癥狀控制繼續(xù)阻滯劑治療繼續(xù)干擾素治療停止干擾素治療直至甲狀腺功能恢復(fù)正常C. CARELLA, et al. Interferon-Related Thyroid Disease:Pathophysiological, Epidemiological, and Cli

9、nical Aspects. The Journal of Clinical Endocrinology & Metabolism.2004; 89(8):36563661.癥狀不能控制Grave病患者病情較輕病情嚴(yán)重抗甲狀腺素治療繼續(xù)干擾素治療放射碘治療停止干擾素治療直至甲狀腺功能恢復(fù)正常C. CARELLA, et al. Interferon-Related Thyroid Disease:Pathophysiological, Epidemiological, and Clinical Aspects. The Journal of Clinical Endocrinology

10、 & Metabolism.2004; 89(8):36563661.Mark F. Prummel and Peter Laurberg, et al. Interferon-a and Autoimmune Thyroid Disease. THYROID. 2003; 13 (6):547-551.C. CARELLA, et al. Interferon-Related Thyroid Disease:Pathophysiological, Epidemiological, and Clinical Aspects. The Journal of Clinical Endocr

11、inology & Metabolism.2004; 89(8):36563661.MELANIE DEUTSCH,et al. Thyroid Abnormalities in Chronic Viral Hepatitis and Their Relationship to Interferon Alfa Therapy. HEPATOLOGY 1997;26:206-210C. CARELLA, et al. Interferon-Related Thyroid Disease:Pathophysiological, Epidemiological, and Clinical A

12、spects. The Journal of Clinical Endocrinology & Metabolism.2004; 89(8):36563661.MELANIE DEUTSCH,et al. Thyroid Abnormalities in Chronic Viral Hepatitis and Their Relationship to Interferon Alfa Therapy. HEPATOLOGY 1997;26:206-210Lotrich FE, et al. Journal of Psychosomatic Research. 2007; 63: 131135.治療期間發(fā)生抑郁的患者治療期間未發(fā)生抑郁的患者Doglas T. Dieterich, Jerry L. Spivak.CID 2003:37-533C. CARELLA, et al. Interferon-Related Thyroid Disease:Pathophysiological, Epidemiological, and Clinical Aspects. The Journal of Clinical E