Objective: To determine the changes brought about by Interferon-Ribavirin combination therapy in the portal blood flow velocity determined by Duplex ultrasound in patients of chronic hepatitis C and to assess the clinical significance of these changes to monitor chronic hepatitis C patients receiving Interferon-Ribavirin combination therapy.
Study design: Quasi experimental study from May 2008 to June 2010.
Setting: Department of Radiology at Jinnah Postgraduate Medical Centre (JPMC) hospital, Karachi.
Methods: Twenty patients (13 female and 7 male; age range 20 to 45 years, mean age 34.35 years) with chronic hepatitis C were included in the study based on the detection of persistently raised levels of alanine aminotransferase (ALT) and positive polymerase chain reaction for hepatitis C virus (HCV). These patients underwent liver biopsy and received Interferon-Ribavirin combination therapy at Jinnah Postgraduate Medical Centre (JPMC). The study also included twenty healthy adult age matched volunteers as control subjects.
The effectiveness of Interferon-Ribavirin combination therapy treatment was evaluated biochemically by serum Alanine aminotransferase (ALT) levels, virologically by hepatitis C virus RNA level estimated by polymerase chain reaction and sonographically by measuring Portal blood flow velocity at the porta hepatis on three occasions:
1. Before initiation of Interferon-Ribavirin combination therapy (pre – IFN).
2. Two weeks after the initiation of Interferon-Ribavirin combination therapy (Week-2).
3. Twenty four weeks after the initiation of Interferon-Ribavirin combination therapy (Week-24).
Results: The patients with chronic hepatitis C in whom Interferon-Ribavirin combination therapy resulted in complete or effective elimination of the viruses showed statistically significant (p˂0.001) increase in portal blood flow velocity at the end of the treatment compared with that before Interferon-Ribavirin combination therapy and also compared to those patients in whom the Interferon-Ribavirin combination therapy did not produce any response.
Conclusion: Doppler sonography is a sensitive and clinically useful diagnostic modality for evaluating the effect of Interferon-Ribavirin combination therapy in patients of chronic hepatitis C.
Key words: Chronic hepatitis C, Interferon, Ribavirin, duplex ultrasound, portal vein hemodynamics.
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