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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

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

引言

接受干扰素加利巴韦林的患者中常见神经精神副作用；这些不良反应可引起治疗失败以及临床决定一开始就不采用该治疗[1]。在美国，极少应用干扰素加利巴韦林的方案。

本专题将总结接受干扰素加利巴韦林治疗的丙型肝炎病毒感染患者中神经精神副作用的识别及危险因素。这些副作用的治疗和预防将单独讨论。 (参见“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”)

抑郁

干扰素加利巴韦林治疗丙型肝炎病毒感染时，最常见的神经精神副作用为抑郁。抑郁的严重程度呈连续性，范围从亚综合征性症状到轻性抑郁和重性抑郁。不同类型抑郁的临床表现和诊断将单独讨论。 (参见“成人单相抑郁：评估及诊断”)

针对干扰素加利巴韦林治疗相关抑郁的各项研究，在所评估的抑郁类型方面有所不同。一些研究将抑郁描述为一种症状(感到低落或者悲伤)[2,3]，而其他研究将抑郁定义为一种综合征，特征为一组明确的情感和躯体症状[4-8]。还有其他研究[1,9-11]通过问卷中的严重程度评分对抑郁进行评估，但这些问卷询问的症状并不一定为美国精神病学会《精神障碍诊断与统计手册(第5版)》(Diagnostic and Statistical Manual, Fifth Edition, DSM-5)认为是重性抑郁的一部分[12]。一般而言，与将抑郁定义为重性抑郁综合征相比，将其定义为一种症状或评定量表中的得分项时更常见(表 1)[13]。

在接受干扰素加利巴韦林的丙型肝炎患者中，单相重性抑郁的发病率较高。一项meta分析纳入22项前瞻性观察性研究，分析了1391例心境正常的慢性丙型肝炎患者开始接受干扰素加利巴韦林治疗后重性抑郁的发病率[14]。开始治疗后，重性抑郁的累积发病率如下：

        

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Literature review current through: 2017-06 . | This topic last updated: 2016-11-21.
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