慢性乙型肝炎患者接受α-2b干扰素治疗后血清及组织学的变化。
Changes in serum and histology of patients with chronic hepatitis B after interferon alpha-2b treatment.
作者信息
Han Hong-Lei, Lang Zhen-Wei
机构信息
Department of Pathology, Beijing Youan Hospital, Beijing 100054, Beijng City, China.
出版信息
World J Gastroenterol. 2003 Jan;9(1):117-21. doi: 10.3748/wjg.v9.i1.117.
AIM
Chronic hepatitis B is a serious health problem. Interferon has long been used to treat Chronic hepatitis B. To evaluate the effects of interferon on chronic hepatitis B better, we designed the study to investigate the changes in sera and liver histology of patients with chronic hepatitis B after interferon alpha-2b treatment.
METHODS
Twenty-four patients with chronic hepatitis B were enrolled in this study. They all received interferon alpha-2b treatment as following: 3 million units, i.m. t.i.w., for 18 weeks. Sera of all patients were obtained respectively for evaluation of ALT, HBsAg, HBcAg, HBeAg, HBV DNA and TIMP-1 before and after interferon treatment, also a liver biopsy pre- and post-treatment was performed for comparison of HAI, HBsAg, HBcAg, HBeAg, TIMP-1 and activated HSC in the liver tissue.
RESULTS
Patients who had normalization of serum ALT and seroconversion of HBeAg and/or HBV DNA (blot hybridization) after treatment were defined as responders. The response rate in this study group was 37.5 % (7/24). Compared to pretreatment, the serum HBV DNA and TIMP-1 decreased significantly (P<0.05), so did the HAI, HBcAg, HBeAg, TIMP-1 and activated HSC (P<0.05).
CONCLUSION
The significant decrease in HBV DNA in sera, the seroconversion of HBeAg, and the decrease of viral expression in liver indicated that interferon alpha-2b treatment can inhibit viral replication. The normalization of ALT in sera and the improvement of HAI in liver showed that interferon alpha-2b can improve the liver histology of patients with chronic hepatitis B. At the same time, interferon alpha-2b treatment can reduce the TIMP-1 in serum and liver and decrease the number of activated HSC, which may alleviate or inhibit hepatic fibrosis. Although the response rate was unsatisfactory, interferon play a beneficial role on patients with chronic hepatitis B in other respects. We still need further studies to improve the therapy effects.
目的
慢性乙型肝炎是一个严重的健康问题。干扰素长期以来一直用于治疗慢性乙型肝炎。为了更好地评估干扰素对慢性乙型肝炎的疗效，我们设计了本研究，以调查慢性乙型肝炎患者在接受α-2b干扰素治疗后血清和肝脏组织学的变化。
方法
本研究纳入了24例慢性乙型肝炎患者。他们均接受如下α-2b干扰素治疗：300万单位，肌肉注射，每周3次，共18周。分别采集所有患者治疗前和治疗后的血清，以评估谷丙转氨酶（ALT）、乙肝表面抗原（HBsAg）、乙肝核心抗原（HBcAg）、乙肝e抗原（HBeAg）、乙肝病毒脱氧核糖核酸（HBV DNA）和基质金属蛋白酶组织抑制因子-1（TIMP-1），同时在治疗前后进行肝脏活检，以比较肝脏活动指数（HAI）、HBsAg、HBcAg、HBeAg、TIMP-1以及肝脏组织中活化肝星状细胞（HSC）的情况。
结果
治疗后血清ALT恢复正常且HBeAg和/或HBV DNA（斑点杂交法）发生血清学转换的患者被定义为应答者。本研究组的应答率为37.5%（7/24）。与治疗前相比，血清HBV DNA和TIMP-1显著降低（P<0.05），HAI、HBcAg、HBeAg、TIMP-1以及活化HSC也显著降低（P<0.05）。
结论
血清中HBV DNA显著降低、HBeAg发生血清学转换以及肝脏中病毒表达减少，表明α-2b干扰素治疗可抑制病毒复制。血清ALT恢复正常以及肝脏HAI改善，表明α-2b干扰素可改善慢性乙型肝炎患者的肝脏组织学。同时，α-2b干扰素治疗可降低血清和肝脏中的TIMP-1，并减少活化HSC的数量，这可能减轻或抑制肝纤维化。尽管应答率不尽人意，但干扰素在其他方面对慢性乙型肝炎患者发挥了有益作用。我们仍需要进一步研究以提高治疗效果。
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