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干扰素-α联合利巴韦林治疗的神经精神副作用：治疗和预防

Authors
Charles L Raison, MD
Nezam H Afdhal, MD, FRCPI
Section Editor
Jonathan M Silver, MD
Deputy Editor
David Solomon, MD
Translators
许毅, 主任医师，教授

引言

目前几乎没有良好设计的研究可为预防或减轻干扰素-α(interferon-alfa, IFN-α)联合利巴韦林引起的神经精神副作用提供确切的指导。庆幸的是，数项安慰剂对照研究通过证实能够有效控制很多患者的这类副作用，而确定了临床经验。然而，下文的推荐主要是基于观察性研究以及在其他情况下治疗精神综合征的经验。

药品说明书中的用药指南(即，治疗抑郁症时IFN-α需减量)并没有充分涵盖对治疗过程中出现的临床问题的处理。特别是在治疗早期阶段，这些指南没有充分考虑控制抑郁与药物剂量减少所致疗效降低之间的折衷。此外，仍需进一步明确通过减少剂量来缓解治疗时出现的神经精神副作用的有效性。

我们认为，更好的治疗策略是利用我们掌握的所有技术(药理和心理社会干预)来使患者能够耐受全剂量IFN-α/利巴韦林并持续一段恰当的时间，同时尽量减少对情绪状态、躯体健康和日常生活功能的负面影响。

本专题将总结使用IFN-α联合利巴韦林治疗丙型肝炎病毒感染的患者中神经精神副作用的治疗和预防。副作用的识别和危险因素参见其他专题。 (参见“干扰素联合利巴韦林治疗丙型肝炎相关的神经精神副作用：识别及危险因素”)

精神科会诊

适合使用IFN-α治疗的患者常被转诊至精神科医生处，以评估发生不良精神结局的风险[1]。精神科医生的职责包括：

                 

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Literature review current through: 2017-06 . | This topic last updated: 2017-06-15.
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