Majda-Stanisławska E, Bednarek M, Jóźwiak B, Sidorkiewicz M, Piekarska A, Kuydowicz J
Department of Infectious Diseases and Hepatology, Medical University of Lodz, Poland.
Acta Gastroenterol Belg. 2006 Apr-Jun;69(2):187-90.
The correlations between the severity of hepatic lesions, age, gender, HBV co-infection and negativisation of HCV-RNA from serum and peripheral blood mononuclear cells (PBMC) after treatment of chronic hepatitis C (CHC) were analysed. 41 children (11 F/ 30 M), aged 5-16 years (mean 10 +/- 2.8), were treated with IFN-alpha and ribavirin for 12 months. Sustained negativisation of HCV-RNA from serum was achieved in 25 patients (61%), in 3 (7%) it reappeared after treatment, and in 13 (32%) it was ineffective. Clearance of HCV did not correlate with age (p = 0.65), sex (p = 0.13), past HBV infection (n = 22 anti-HBc +) (p = 0.24), maximum pre-treatment ALT activity (p = 0.06), grade of inflammation (p = 0.33) or stage of fibrosis (p = 0.9) in liver biopsy. It was achieved in 6/16 children previously resistant to IFN-a monotherapy and in 19/25 naive (p = 0.017). HCV-RNA was detected in PBMC in 9/24 (37%) seronegative children and in 1/21 (5%) in comparative group of seronegative adults; p = 0.004. Persistence of HCV-RNA in PBMC after combined treatment occurred in 5/10 (50%) patients resistant to previous IFN-alpha monotherapy, 6/35 (20%) of them cleared HCV from PBMC (p = 0.04).
Age and gender, infection route, history of HBV infection or severity of histopathologic liver lesions had no influence on the efficacy of treatment with IFN-alpha and ribavirin. Clearance of HCV from serum and from PBMC occurs less frequently in patients previously resistant to IFN-alpha. Children with CHC require longitudinal observation after successful antiviral treatment as in 37% of those considered to be free from the virus by ordinary measures, HCV-RNA was found in PBMC.
分析了慢性丙型肝炎（CHC）治疗后肝损伤严重程度、年龄、性别、乙肝病毒（HBV）合并感染与血清及外周血单个核细胞（PBMC）中丙型肝炎病毒核糖核酸（HCV-RNA）转阴之间的相关性。41名年龄在5至16岁（平均10±2.8岁）的儿童（11名女性/30名男性）接受了α干扰素和利巴韦林治疗12个月。25名患者（61%）实现了血清HCV-RNA持续转阴，3名患者（7%）治疗后复发，13名患者（32%）治疗无效。HCV清除与年龄（p = 0.65）、性别（p = 0.13）、既往HBV感染（n = 22名抗-HBc阳性）（p = 0.24）、治疗前最高丙氨酸氨基转移酶（ALT）活性（p = 0.06）、炎症分级（p = 0.33）或肝活检纤维化分期（p = 0.9）均无相关性。6/16名既往对α干扰素单药治疗耐药的儿童和19/25名初治儿童实现了HCV清除（p = 0.017）。9/24名（37%）血清学阴性儿童的PBMC中检测到HCV-RNA，而血清学阴性成人对照组中1/21名（5%）检测到；p = 0.004。联合治疗后，5/10名（50%）既往对α干扰素单药治疗耐药的患者PBMC中HCV-RNA持续存在，其中6/35名（20%）患者PBMC中的HCV清除（p = 0.04）。
年龄、性别、感染途径、HBV感染史或肝组织病理损伤严重程度对α干扰素和利巴韦林治疗效果无影响。既往对α干扰素耐药的患者血清和PBMC中HCV清除率较低。CHC儿童抗病毒治疗成功后需要长期观察，因为在常规方法认为无病毒的儿童中，37%的儿童PBMC中检测到HCV-RNA。
