Boxall Elizabeth H, Sira Jaswant, Ballard Anna L, Davies Paul, Kelly Deirdre A
Liver Unit, Birmingham Children's Hospital NHS Trust, Birmingham, United Kingdom.
J Med Virol. 2006 Jul;78(7):888-95. doi: 10.1002/jmv.20637.
The long-term outcome of treatment with Interferon Alpha 2B with and without Prednisolone priming in children infected perinatally with hepatitis B was reviewed. The group studied included 48 children (aged 2-16 years), who were HBe antigen and hepatitis B DNA positive between 1991 and 1993. Twenty children were randomized to a therapeutic trial at that time, and received Prednisolone in reducing doses for 6 weeks and Interferon for 16 weeks while 22 children were monitored without treatment for 12 months. Fourteen of the untreated group and 6 additional children later received treatment with Interferon alone (n = 20). Eight children for whom treatment was declined were followed long term. Median follow-up was 7.5 years (range 1.5-10.6). There was no significant effect of Interferon therapy on seroconversion with or without Prednisolone at 12 months post-treatment compared to untreated children. On longer term follow-up, the 5-year HBeAg to anti-HBe seroconversion percentages, estimated from Kaplan-Meier curves, were 54% for Prednisolone plus Interferon, 22% for Interferon alone, and 12% for untreated children. The median time to seroconversion was 3.9 years (range 0.4-8.2) and was shortest in those treated with Prednisolone plus Interferon. Children who had elevated hepatic transaminase enzymes prior to treatment or during Prednisolone priming had a better response. In contrast to many European studies, no child cleared HBsAg and produced anti-HBs. Treatment with Prednisolone priming and Interferon, improved both the time and rate of seroconversion compared to no treatment or Interferon alone, suggesting that this combination of drugs might have an immunomodulatory effect.
回顾了在围产期感染乙肝的儿童中，使用或不使用泼尼松龙预治疗的α-2B干扰素治疗的长期结果。研究组包括48名儿童（年龄在2至16岁之间），他们在1991年至1993年间HBe抗原和乙肝DNA呈阳性。当时20名儿童被随机分配到一项治疗试验中，接受逐渐减量的泼尼松龙治疗6周和干扰素治疗16周，而22名儿童未接受治疗，被监测12个月。未治疗组中的14名儿童以及另外6名儿童后来单独接受了干扰素治疗（n = 20）。8名拒绝治疗的儿童接受了长期随访。中位随访时间为7.5年（范围1.5至10.6年）。与未治疗的儿童相比，治疗后12个月时，无论有无泼尼松龙，干扰素治疗对血清学转换均无显著影响。在更长时间的随访中，根据Kaplan-Meier曲线估计，泼尼松龙加干扰素组的5年HBeAg到抗-HBe血清学转换率为54%，单独使用干扰素组为22%，未治疗儿童组为12%。血清学转换的中位时间为3.9年（范围0.4至8.2年），在接受泼尼松龙加干扰素治疗的儿童中最短。治疗前或泼尼松龙预治疗期间肝转氨酶升高的儿童反应更好。与许多欧洲研究不同的是，没有儿童清除HBsAg并产生抗-HBs。与不治疗或单独使用干扰素相比，泼尼松龙预治疗和干扰素治疗改善了血清学转换的时间和速率，表明这种药物组合可能具有免疫调节作用。
