Scotto G
Divisione Malattie Infettive, OO.RR., Foggia, Italy.
Infez Med. 1997 Jul;5(3):168-73.
Hepatitis C is a very serious disease. If it is not treated, it leads to chronic hepatitis and cirrhosis in 50% and 20% of cases, respectively. Furthermore, patients with cirrhosis might develop hepatocarcinoma. Interferon seems to be the therapy of choice in the treatment of the disease. However, since the molecule cannot always be used (non-compliant patient; severe side effects; liver-associated pathologies; patient age) alternative therapies have been investigated. Ursodeoxycholic acid (UDCA) stands out among recommended non-antiviral molecules. 74 patients affected by HCV chronic infections were enrolled in this single-blind study. One group (A: 37 patients) was treated with UDCA (600 mg/day for 12 months) and compared with a control group (B: 37 patients) in order to assess the therapy efficacy in reducing cytolysis index and to estimate viraemia and histologic score variation.
13 patients did not complete the study (8 belonging to group A; 5 to group B). 65,5% of the patients treated with UDCA showed ALT reduction; 42,1% of them with complete response. The situation remained unchanged in 15 patients all the treatment along. In the group B, only 12,5% showed a significant ALT reduction. During the follow-up, in 69,4% of group-A responders ALT was found to return to pre-treatment values. No variation was observed in the viraemia and histologic score of patients who had accepted a control biopsy.
UDCA is undoubtedly suitable for reducing cytolysis index in patients with HCV chronic infections. It is well tolerated but it does not modify the disease natural course.
丙型肝炎是一种非常严重的疾病。如果不进行治疗,分别有50%和20%的病例会发展为慢性肝炎和肝硬化。此外,肝硬化患者可能会发展为肝癌。干扰素似乎是治疗该疾病的首选疗法。然而,由于该分子并非总能使用(患者不依从;严重副作用;肝脏相关病变;患者年龄),因此人们对替代疗法进行了研究。熊去氧胆酸(UDCA)在推荐的非抗病毒分子中脱颖而出。74名受丙型肝炎病毒慢性感染的患者参与了这项单盲研究。一组(A组:37名患者)接受UDCA治疗(600毫克/天,持续12个月),并与对照组(B组:37名患者)进行比较,以评估该疗法在降低细胞溶解指数方面的疗效,并估计病毒血症和组织学评分的变化。
13名患者未完成研究(A组8名;B组5名)。接受UDCA治疗的患者中有65.5%的人谷丙转氨酶(ALT)降低;其中42.1%完全缓解。15名患者在整个治疗过程中情况未变。在B组中,只有12.5%的人ALT有显著降低。在随访期间,A组有反应者中69.4%的人ALT恢复到治疗前水平。接受对照活检的患者的病毒血症和组织学评分未观察到变化。
UDCA无疑适用于降低丙型肝炎病毒慢性感染患者的细胞溶解指数。它耐受性良好,但不会改变疾病的自然病程。