vspВопросы современной педиатрииCurrent Pediatrics1682-55271682-5535Издательство «ПедиатрЪ»10.15690/vsp.v12i3.684vsp-333Research ArticleВ ПОМОЩЬ ВРАЧУA DOCTOR’S AIDЧАСТОТА ВСТРЕЧАЕМОСТИ ПОБОЧНЫХ ЯВЛЕНИЙ ИНТЕРФЕРОНОТЕРАПИИ У ДЕТЕЙ С ХРОНИЧЕСКИМ ВИРУСНЫМ ГЕПАТИТОМ СPREVALENCE OF SIDE EFFECTS OF INTERFERON THERAPY IN CHILDREN WITH CHRONIC VIRAL HEPATITIS CСкворцоваТ. А.SkvortsovaT. A.

Skvortsova Tamara Andreevna, PhD student of the Department of Gastroenterology and Hepathology of Scientific Center of Children’s Health, RAMS

skvortsova_t@nczd.ruВолынецГ. В.VolynetsG. V.skvortsova_t@nczd.ruПотаповА. С.PoyapovA. S.skvortsova_t@nczd.ruСемикинаЕ. Л.SemikinaE. L.skvortsova_t@nczd.ruНаучный центр здоровья детей РАМН, МоскваРоссияScientific Centre of Children Health of RAMS, MoscowRussian FederationНаучный центр здоровья детей РАМН, Москва,; Первый Московский государственный медицинский университет им. И.М. Сеченова,РоссияScientific Centre of Children Health of RAMS, Moscow; I.M. Sechenov First Moscow State Medical University,Russian Federation201314052013123Вопросы современной педиатрии7073Copyright © Скворцова Т.А., Волынец Г.В., Потапов А.С., Семикина Е.Л., 20132013Скворцова Т.А., Волынец Г.В., Потапов А.С., Семикина Е.Л.Skvortsova T.A., Volynets G.V., Poyapov A.S., Semikina E.L.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vsp.spr-journal.ru/jour/article/view/333

Цель исследования: произвести оценку эффективности и частоты встречаемости побочных явлений интерферонотерапии при хроническом вирусном гепатите С. Пациенты и методы исследования: наблюдали 93 ребенка в возрасте от 3 до 17 (10,0±0,8 лет) лет с хроническим гепатитом С; 65 детей имели генотип 1 и 28 — генотип 2/3 вируса гепатита С. Всем пациентам до начала противовирусной терапии были проведен стандартный набор лабораторно-инструментальных исследований. В зависимости от схемы противовирусной терапии выделено 3 группы пациентов. Осуществляли анализ клинических проявлений, оценку изменения лабораторных показателей крови, а также контроль массы и роста ребенка. Результаты: данные исследования продемонстрировали высокую частоту встречаемости побочных явлений при использовании рекомбинантного интерферона α и еще большую — при применении пегилированного интерферона α в комбинации с рибавирином. Это в ряде случаев обусловливало необходимость коррекции дозы препаратов. Показано также, что использование рекомбинантного интерлейкина 2 с рекомбинантным интерфероном α при лечении хронического гепатита С у детей значительно снижает частоту встречаемости и степень выраженности побочных эффектов. Это объясняется способностью интерлейкина 2 к нивелированию антипролиферативного эффекта интерферонотерапии. Выводы: использование рекомбинантного интерлейкина 2 в комплексе с рекомбинантным интерфероном α при лечении хронического гепатита С значительно снижает частоту встречаемости и степень выраженности побочных эффектов.

Aim: to assess efficacy and safety of interferon therapy in children with chronic viral hepatitis C. Patients and methods: 93 childrenaged from 3 to 17 (10,0±0,8 years) years old with chronic viral hepatitis C were included into the study. Among them 65 patientshad hepatitis C viral genotype 1 and 28 — genotype 2/3. All the patients before the beginning of antiviral treatment were performed a routine laboratory and instrumental examination. According to the scheme of antiviral therapy 3 different groups of children were distinguished. Analysis of clinical manifestations, assessment of changes in blood markers and control of body weight and height were carried out. Results: received data showed high prevalence of side effects of recombinant interferon α and even higher — of pegylated interferon α in combination with ribavirin. In a number of cases this required correction of drug dosages. It was also shown that usage of recombinant interleukin 2 with recombinant interferon in treatment of chronic hepatitis C in children significantly decreases prevalence and severity of side effects. This can be explained by the ability of interleukin 2 to levelling of antiproliferative effect of interferon therapy. Conclusions: usage of recombinant interleukin 2 in combination with recombinant interferon α in treatment of chronic hepatitis C significantly decrease prevalence and severity of side effects.

хронический вирусный гепатит Сзаболеваемость детского населенияинтерферонотерапияпротивовирусная терапияchronic viral hepatitis Cmorbidity of children populationinterferon therapyantiviral therapypegylated interferon αribavirinrecombinant interferon αrecombinant interleukin 2ReferencesDelgado-Borrego A. Treating hepatitis C: are children the same as adults? Gastroenterology. 2011; 140: 389–392.Delgado-Borrego A. Treating hepatitis C: are children the same as adults? Gastroenterology. 2011; 140: 389–392.Baranov A. A., Namazova-Baranova L. S., Volynets G. V., Potapov A. S., Il'in A. G., Konova S. R., Skvortsova T. A., Pakhomovskaya N. L., Chetkina T. S. Mediko-statisticheskii obzor «Zabole vae most' khronicheskimi virusnymi gepatitami detskogo naseleniya v Rossiiskoi Federatsii za period 2003–2011 gg.» [Medico-statistical review “Rate of Morbidity of Chronic Viral Hepatitis in Children in Russian Federation during the period of 2003–2011”]. Moscow, 2012. pp. 1–15.Baranov A. A., Namazova-Baranova L. S., Volynets G. V., Potapov A. S., Il'in A. G., Konova S. R., Skvortsova T. A., Pakhomovskaya N. L., Chetkina T. S. Mediko-statisticheskii obzor «Zabole vae most' khronicheskimi virusnymi gepatitami detskogo naseleniya v Rossiiskoi Federatsii za period 2003–2011 gg.» [Medico-statistical review “Rate of Morbidity of Chronic Viral Hepatitis in Children in Russian Federation during the period of 2003–2011”]. Moscow, 2012. pp. 1–15.Volynets G. V., Skvortsova T. A. Mediko-sotsial'naya ekspertiza i reabilitatsiya — Medico-social evaluation and rehabilitation. 2011; 3–4: 30–48.Volynets G. V., Skvortsova T. A. Mediko-sotsial'naya ekspertiza i reabilitatsiya — Medico-social evaluation and rehabilitation. 2011; 3–4: 30–48.Bortolotti F., Vajro P., Cadrobbi P., Lepore L., Zancan L., Barbera C., Crivellaro C. et al. Cryptogenic chronic liver disease and hepatitis C virus infection in children. J. Hepatol. 1992; 15: 73–76.Bortolotti F., Vajro P., Cadrobbi P., Lepore L., Zancan L., Barbera C., Crivellaro C. et al. Cryptogenic chronic liver disease and hepatitis C virus infection in children. J. Hepatol. 1992; 15: 73–76.Kage M., Fujisawa T., Shiraki K., Tanaka T., Kimura A., Shi-ma matsu K., Nakashima E. et al. Pathology of chronic hepatitis C in children. Child Liver Study Group of Japan. Hepatology. 1997; 26: 771–775.Kage M., Fujisawa T., Shiraki K., Tanaka T., Kimura A., Shi-ma matsu K., Nakashima E. et al. Pathology of chronic hepatitis C in children. Child Liver Study Group of Japan. Hepatology. 1997; 26: 771–775.Badizadegan K., Jonas M. M., Ott M. J., Nelson S. P., PerezAtayde A. R. Histopathology of the liver in children with chronic hepatitis C viral infection. Hepatology. 1998; 28: 1416–1423.Badizadegan K., Jonas M. M., Ott M. J., Nelson S. P., PerezAtayde A. R. Histopathology of the liver in children with chronic hepatitis C viral infection. Hepatology. 1998; 28: 1416–1423.Guido M., Rugge M., Jara P., Hierro L., Giacchino R., Larra-uri J., Zancan L. et al. Chronic hepatitis C in children: the pathological and clinical spectrum. Gastroenterology. 1998; 115: 1525–1529.Guido M., Rugge M., Jara P., Hierro L., Giacchino R., Larra-uri J., Zancan L. et al. Chronic hepatitis C in children: the pathological and clinical spectrum. Gastroenterology. 1998; 115: 1525–1529.Birnbaum A. H., Shneider B. L., Moy L. Hepatitis C in children. N. Engl. J. Med. 2000; 342: 290–291.Birnbaum A. H., Shneider B. L., Moy L. Hepatitis C in children. N. Engl. J. Med. 2000; 342: 290–291.Gonzblez-Peralta R.P., Langham M. R., Jr., Andres J. M. et al. Hepatocellular carcinoma in 2 young adolescents with chronic hepatitis C. J. Pediatr. Gastroenterol. Nutr. 2009; 48: 630–635.Gonzblez-Peralta R.P., Langham M. R., Jr., Andres J. M. et al. Hepatocellular carcinoma in 2 young adolescents with chronic hepatitis C. J. Pediatr. Gastroenterol. Nutr. 2009; 48: 630–635.Mohan P., Colvin C. A., Glymph C. et al. Clinical spectrum and histopathologic features of chronic hepatitis C infection in children. J. Pediatr. 2007; 150: 168–174.Mohan P., Colvin C. A., Glymph C. et al. Clinical spectrum and histopathologic features of chronic hepatitis C infection in children. J. Pediatr. 2007; 150: 168–174.Nydegger A., Srivastava A., Wake M. et al. Health-related quality of life in children with hepatitis C acquired in the first year of life. J. Gastroenterol. Hepatol. 2008; 23: 226–230.Nydegger A., Srivastava A., Wake M. et al. Health-related quality of life in children with hepatitis C acquired in the first year of life. J. Gastroenterol. Hepatol. 2008; 23: 226–230.Rodrigue J. R., Balistreri W., Haber B. et al. Impact of hepatitis C virus infection on children and their caregivers: quality of life, cognitive, and emotional outcomes. J. Pediatr. Gastroenterol. Nutr. 2009; 48: 341–347.Rodrigue J. R., Balistreri W., Haber B. et al. Impact of hepatitis C virus infection on children and their caregivers: quality of life, cognitive, and emotional outcomes. J. Pediatr. Gastroenterol. Nutr. 2009; 48: 341–347.Serranti D., Buonsenso D., Ceccarelli M. et al. Pediatric hepatitis C infection: to treat or not to treat… what's the best for the child? Eur. Rev. Med. Pharmacol. Sci. 2011; 15: 1057–1067.Serranti D., Buonsenso D., Ceccarelli M. et al. Pediatric hepatitis C infection: to treat or not to treat… what's the best for the child? Eur. Rev. Med. Pharmacol. Sci. 2011; 15: 1057–1067.Danish F. A., Koul S. S., Subhani F. R. et al. Managing HCV infection in pediatric age group: suggested recommendations. Saudi J. Gastroenterol. 2010; 16: 230–235.Danish F. A., Koul S. S., Subhani F. R. et al. Managing HCV infection in pediatric age group: suggested recommendations. Saudi J. Gastroenterol. 2010; 16: 230–235.Yeung L. T., Roberts E. A. Current issues in the management of paediatric viral hepatitis. Liver Int. 2010; 30: 5–18.Yeung L. T., Roberts E. A. Current issues in the management of paediatric viral hepatitis. Liver Int. 2010; 30: 5–18.Arshad M., El-Kamary S. S., Jhaveri R. Hepatitis C virus infection during pregnancy and the newborn period — are they opportunities for treatment? J. Viral Hepat. 2011; 18: 229–236.Arshad M., El-Kamary S. S., Jhaveri R. Hepatitis C virus infection during pregnancy and the newborn period — are they opportunities for treatment? J. Viral Hepat. 2011; 18: 229–236.Powell M., Bailey J., Maggio L. A. Clinical inquiries. How should you manage children born to hepatitis C-positive women? J. Fam. Pract. 2010; 59: 289–290.Powell M., Bailey J., Maggio L. A. Clinical inquiries. How should you manage children born to hepatitis C-positive women? J. Fam. Pract. 2010; 59: 289–290.Tajiri H., Inui A., Kiyohara Y. et al. Peginterferon alpha-2b and ribavirin for the treatment of chronic hepatitis C in Japanese pediatric and young adult patients: a survey of the Japan Society of Pediatric Hepatology. Eur. J. Gastroenterol. Hepatol. 2009; 21: 1256–1260.Tajiri H., Inui A., Kiyohara Y. et al. Peginterferon alpha-2b and ribavirin for the treatment of chronic hepatitis C in Japanese pediatric and young adult patients: a survey of the Japan Society of Pediatric Hepatology. Eur. J. Gastroenterol. Hepatol. 2009; 21: 1256–1260.American Academy of Pediatrics. Committee on Infectious Diseases. Hepatitis C virus infection. Pediatrics. 1998; 101 (3, Pt. 1): 481–485.American Academy of Pediatrics. Committee on Infectious Diseases. Hepatitis C virus infection. Pediatrics. 1998; 101 (3, Pt. 1): 481–485.Zhang H. F., Yang X. J., Shu S. S. et al. An open-label pilot study evaluating the efficacy and safety of peginterferon alfa-2a combined with ribavirin in children with chronic hepatitis C. Zhonghua Shi. Yan. He. Lin. Chuang Bing. Du. Xue. Za. Zhi. 2005; 19: 185–187.Zhang H. F., Yang X. J., Shu S. S. et al. An open-label pilot study evaluating the efficacy and safety of peginterferon alfa-2a combined with ribavirin in children with chronic hepatitis C. Zhonghua Shi. Yan. He. Lin. Chuang Bing. Du. Xue. Za. Zhi. 2005; 19: 185–187.Schwarz K. B., Mohan P., Markewicz C. et al. Safety, efficacy and pharmacokinetics of peginterferon alpha2a (40 kd) in children with chronic hepatitis C. J. Pediatr. Gastroenterol. Nutr. 2006; 43: 499–505.Schwarz K. B., Mohan P., Markewicz C. et al. Safety, efficacy and pharmacokinetics of peginterferon alpha2a (40 kd) in children with chronic hepatitis C. J. Pediatr. Gastroenterol. Nutr. 2006; 43: 499–505.Volynets G. V., Potapov A. S., Pakhomovskaya N. L., Skvortsova T. A. Povyshenie effektivnosti i bezopasnosti interferonoterapii khronicheskogo gepatita S u detei s pomoshch'yu Ronkoleikina — rekombinantnogo interleikina 2. Mediko-statisticheskii obzor «Zabolevaemost' khronicheskimi virusnymi gepatitami detskogo naseleniya v Rossiiskoi federatsii za period 2003–2011 gg.» [Efficiency and Safe Improvement of IF Therapy of Chronic Hepatitis C in Children with the Help of Roncoleikin — recombinant interleukin 2. Medicostatistical review “Rate of Morbidity of Chronic Viral Hepatitis in Children in Russian Federation during the period of 2003–2011”]. Moscow, 2012. pp. 33–37.Volynets G. V., Potapov A. S., Pakhomovskaya N. L., Skvortsova T. A. Povyshenie effektivnosti i bezopasnosti interferonoterapii khronicheskogo gepatita S u detei s pomoshch'yu Ronkoleikina — rekombinantnogo interleikina 2. Mediko-statisticheskii obzor «Zabolevaemost' khronicheskimi virusnymi gepatitami detskogo naseleniya v Rossiiskoi federatsii za period 2003–2011 gg.» [Efficiency and Safe Improvement of IF Therapy of Chronic Hepatitis C in Children with the Help of Roncoleikin — recombinant interleukin 2. Medicostatistical review “Rate of Morbidity of Chronic Viral Hepatitis in Children in Russian Federation during the period of 2003–2011”]. Moscow, 2012. pp. 33–37.The European Association for the Study of the Liver (EASL). Monitoring response to treatment and duration of HCV treatment depending on the severity of virology response with the HCV genotype. Vienna, Austria. 2010.The European Association for the Study of the Liver (EASL). Monitoring response to treatment and duration of HCV treatment depending on the severity of virology response with the HCV genotype. Vienna, Austria. 2010.Pellicano R. Autoimmune manifestation during interferon therapy in patients with chronic hepatitis C: the hepatologist’s view. Minerva Gastroenterol. Dietol. 2005; 51: 55–61.Pellicano R. Autoimmune manifestation during interferon therapy in patients with chronic hepatitis C: the hepatologist’s view. Minerva Gastroenterol. Dietol. 2005; 51: 55–61.Peck-Radosavljevic M. Rapid suppression of hematopoiesis by standard or pegylated interferon-alpha. Gastroenterology. 2002; 123: 141–151.Peck-Radosavljevic M. Rapid suppression of hematopoiesis by standard or pegylated interferon-alpha. Gastroenterology. 2002; 123: 141–151.

The authors declare that there are no conflicts of interest present.