Melhem Alla, Stern Mirela, Shibolet Oren, Israeli Eran, Ackerman Zvi, Pappo Orit, Hemed Nilla, Rowe Mina, Ohana Hana, Zabrecky George, Cohen Robert, Ilan Yaron
Liver Unit, Department of Medicine, Hebrew University, Hadassah Medical Center, Jerusalem, Israel.
J Clin Gastroenterol. 2005 Sep;39(8):737-42. doi: 10.1097/01.mcg.0000174023.73472.29.
The pathogenesis of chronic hepatitis C virus (HCV) infection is associated with a defective host antiviral immune response and intrahepatic oxidative stress. Oxidative stress and lipid peroxidation play major roles in the fatty liver accumulation (steatosis) that leads to necro-inflammation and necrosis of hepatic cells. Previous trials suggested that antioxidative therapy may have a beneficial effect on patients with chronic HCV infection.
To determine the safety and efficacy of treatment of chronic HCV patients via a combination of antioxidants.
Fifty chronic HCV patients were treated orally on a daily basis for 20 weeks with seven antioxidative oral preparations (glycyrrhizin, schisandra, silymarin, ascorbic acid, lipoic acid, L-glutathione, and alpha-tocopherol), along with four different intravenous preparations (glycyrrhizin, ascorbic acid, L-glutathione, B-complex) twice weekly for the first 10 weeks, and followed up for an additional 20 weeks. Patients were monitored for HCV-RNA levels, liver enzymes, and liver histology. Assessment of quality of life was performed using the SF-36 questionnaire.
In one of the tested parameters (eg, liver enzymes, HCV RNA levels, or liver biopsy score), a combination of antioxidants induced a favorable response in 48% of the patients (24). Normalization of liver enzymes occurred in 44% of patients who had elevated pretreatment ALT levels (15 of 34). ALT levels remained normal throughout follow-up period in 72.7% (8 of 11). A decrease in viral load (one log or more) was observed in 25% of the patients (12). Histologic improvement (2-point reduction in the HAI score) was noted in 36.1% of the patients. The SF-36 score improved in 26 of 45 patients throughout the course of the trial (58% of the patients). Treatment was well tolerated by all patients. No major adverse reactions were noted.
These data suggest that multi antioxidative treatment in chronic HCV patients is well tolerated and may have a beneficial effect on necro-inflammatory variables. A combination of antiviral and antioxidative therapies may enhance the overall response rate of these patients.
慢性丙型肝炎病毒（HCV）感染的发病机制与宿主抗病毒免疫反应缺陷及肝内氧化应激有关。氧化应激和脂质过氧化在导致肝细胞坏死性炎症和坏死的脂肪肝积累（脂肪变性）中起主要作用。先前的试验表明，抗氧化治疗可能对慢性HCV感染患者有益。
确定联合使用抗氧化剂治疗慢性HCV患者的安全性和有效性。
50例慢性HCV患者每天口服7种抗氧化口服制剂（甘草酸、五味子、水飞蓟素、抗坏血酸、硫辛酸、L-谷胱甘肽和α-生育酚），持续20周，同时在前10周每周两次静脉注射4种不同制剂（甘草酸、抗坏血酸、L-谷胱甘肽、复合维生素B），并额外随访20周。对患者进行HCV-RNA水平、肝酶和肝脏组织学监测。使用SF-36问卷进行生活质量评估。
在其中一项测试参数（如肝酶、HCV RNA水平或肝活检评分）中，抗氧化剂联合使用使48%的患者（24例）产生了良好反应。44%预处理ALT水平升高的患者（34例中的15例）肝酶恢复正常。72.7%（11例中的8例）患者在整个随访期内ALT水平保持正常。25%的患者（12例）病毒载量下降（一个对数或更多）。36.1%的患者组织学改善（HAI评分降低2分）。在整个试验过程中，45例患者中的26例（58%的患者）SF-36评分有所改善。所有患者对治疗耐受性良好。未观察到重大不良反应。
这些数据表明，慢性HCV患者的多重抗氧化治疗耐受性良好，可能对坏死性炎症变量有有益影响。抗病毒和抗氧化治疗联合使用可能提高这些患者的总体反应率。
