Mozer-Lisewska Iwona, Słuzewski Wojciech, Ali Youseif Khaled, Figlerowicz Magdalena, Kowala-Piaskowska Arleta
Department of Infectious Diseases and Child Neurology, Institute of Paediatrics, Karol Marcinkowski University of Medical Sciences, 27/33 Szpitalna Strasse, 60-572, Poznań, Poland.
Eur J Pediatr. 2003 Nov;162(11):755-9. doi: 10.1007/s00431-002-1147-x. Epub 2003 Aug 22.
Interferon alpha (IFN-alpha) remains the basic modality in the treatment of chronic hepatitis C in children, but the effects of therapy are still unsatisfactory. The aim of this study was to evaluate parameters linked to IFN-alpha response within a 2-year period. Human C virus (HCV) infected children (n=34) were subdivided into IFN-treated (n=20) and IFN-untreated (n=14 control) groups. The IFN-treated group received a dosage 3 MU of IFN-alpha three times a week for 24 weeks. Liver biopsy was performed in all IFN-treated children and the HCV genotype was determined before the start of the study. Patients were sequentially screened for alanine transaminase (ALT) activity and tested for the presence of HCV-RNA in serum. All patients had either mild persistent or moderate active hepatitis, which was diagnosed from the liver biopsy. In the IFN-treated group ALT normalisation was observed by the end of treatment in 9/20 patients, but after 6 months 10 patients (50%) had sustained ALT normalisation and in 4 of them the virus was eliminated. They continued to show these features up to the end of the observation period (2 years). Eighteen out of 24 children tested had 1b genotype of virus. Out of 10 responders, all patients who were clear of HCV had the 1b genotype. The median age of responders (6.0, range 3.8-16) was significantly lower than non-responders (14.0, range 4-15) In the control group none of the children were clear of HCV-RNA.
The negative predictive effect of HCV genotype 1b in the course of IFN-alpha treatment may be not valid in children and other features have to be taken into account in the assessment of the efficacy of therapy.
干扰素α（IFN-α）仍是儿童慢性丙型肝炎治疗的基本方式，但治疗效果仍不尽人意。本研究旨在评估2年内与IFN-α反应相关的参数。将人类C型病毒（HCV）感染儿童（n = 34）分为IFN治疗组（n = 20）和未接受IFN治疗组（n = 14，对照组）。IFN治疗组每周三次接受3 MU的IFN-α剂量，共24周。对所有接受IFN治疗的儿童进行肝活检，并在研究开始前确定HCV基因型。对患者依次进行丙氨酸转氨酶（ALT）活性筛查，并检测血清中HCV-RNA的存在情况。所有患者均患有轻度持续性或中度活动性肝炎，这是通过肝活检诊断的。在IFN治疗组中，9/20的患者在治疗结束时ALT恢复正常，但6个月后，10名患者（50%）的ALT持续正常，其中4名患者的病毒被清除。直至观察期结束（2年），他们仍保持这些特征。在接受检测的24名儿童中，有18名儿童的病毒基因型为1b型。在10名反应者中，所有清除HCV的患者均为1b基因型。反应者的中位年龄（6.0，范围3.8 - 16岁）显著低于无反应者（14.0，范围4 - 15岁）。在对照组中，没有儿童清除HCV-RNA。
HCV基因型1b在IFN-α治疗过程中的阴性预测作用在儿童中可能无效，在评估治疗效果时必须考虑其他特征。
