Torii Nobuyuki, Hasegawa Kiyoshi, Ogawa Miho, Hashimo Etsuko, Hayashi Naoaki
Institute of Gastroenterology, Tokyo Women's Medical University, 8-1, Kawadacho, Shinjuku-ku, 162-8666, Tokyo, Japan
Hepatol Res. 2002 Sep;24(1):34. doi: 10.1016/s1386-6346(02)00009-8.
We describe lamivudine therapy for acute hepatitis B (AHB) with prolonged high alanine aminotransferase (ALT) and HBV DNA. Three male patients (27-31 years old) had prolonged high ALT, bilirubinemia, and prolonged prothrombin time for over 10 days. Lamivudine was administered at a dose of 150 mg per day because of the threat of acute liver failure. All three patients tolerated the drug well. Serum HBV DNA levels quickly became undetectable, and both the ALT level and liver function tests normalized within 1 month in all three patients. HBeAg and HBsAg disappeared during the clinical course of AHB, and HBsAb was not detected in two of the three patients during the 1-year follow-up. Direct sequence analysis revealed no significant substitution of amino acids in the precore and core regions, including the HLA class II epitope. Lamivudine might prevent the progression of severe AHB to fulminant liver failure, and it appears to modify the clinical course of the disease.
我们描述了拉米夫定治疗伴有长时间高丙氨酸氨基转移酶（ALT）和乙肝病毒（HBV）DNA的急性乙型肝炎（AHB）的情况。三名男性患者（年龄27 - 31岁）出现长时间的高ALT、胆红素血症以及超过10天的凝血酶原时间延长。由于存在急性肝衰竭的风险，给予拉米夫定每日150毫克的剂量。所有三名患者对该药物耐受性良好。血清HBV DNA水平迅速变得检测不到，并且所有三名患者的ALT水平和肝功能检查在1个月内均恢复正常。在AHB的临床过程中，HBeAg和HBsAg消失，在为期1年的随访中，三名患者中有两名未检测到HBsAb。直接序列分析显示在前核心和核心区域，包括HLA II类表位，未发现氨基酸有明显替代。拉米夫定可能会阻止严重AHB进展为暴发性肝衰竭，并且似乎会改变该疾病的临床病程。
