Roznovský L, Orságová I, Kloudová A, Mrázek J
Department of Infectious Diseases, University Hospital Ostrava, 17. listopadu 1790, 708 00 Ostrava, Czech Republic.
Klin Mikrobiol Infekc Lek. 2007 Apr;13(2):59-65.
Fulminant hepatitis develops in 1 % of patients with acute hepatitis B. Lamivudine therapy in patients with severe acute hepatitis B probably reduces their risk of fulminant hepatitis but experience with this type of treatment is still limited.
Between 1999 and 2006, 17 immunocompetent patients (12 women, 5 men, age 17-83 years) with severe acute hepatitis B were treated with lamivudine. Prior to treatment, all patients had their total bilirubin values above 220 micromol/l (more than 13 mg/dl). In 9 patients, the marked increase of bilirubin levels was accompanied by aminotransferase level decrease. Sixteen patients received lamivudine at a dose of 100 mg per day; one patient was given 150 mg daily. In 12 patients, concurrent corticosteroid therapy was administered.
One patient developed fulminant hepatitis B and underwent successful urgent liver transplantation 5 days after the lamivudine therapy was initiated. Sixteen patients responded well to the treatment and their biochemical parameters improved rapidly. Within 3-7 months, the HBsAg was undetectable in 14 out of 15 investigated patients. Protective anti-HBs antibodies developed in 11 of them in 3-21 months. The lamivudine therapy was terminated in 12 patients and it continued for more than 1 year in 3 patients only. Four patients continue to receive lamivudine but the therapy still has not exceeded 9 months. The corticosteroid therapy was short-term; it was longer than one month in 1 of 12 patients.
Early treatment with lamivudine alone or with corticosteroids probably decreases the risk of progression to fulminant hepatitis in patients with severe acute hepatitis B.
暴发性肝炎在1%的急性乙型肝炎患者中发生。拉米夫定治疗重度急性乙型肝炎患者可能会降低其发生暴发性肝炎的风险，但此类治疗的经验仍有限。
1999年至2006年期间，17例免疫功能正常的重度急性乙型肝炎患者（12例女性，5例男性，年龄17 - 83岁）接受了拉米夫定治疗。治疗前，所有患者的总胆红素值均高于220微摩尔/升（超过13毫克/分升）。9例患者胆红素水平显著升高的同时伴有转氨酶水平下降。16例患者接受每日100毫克的拉米夫定治疗；1例患者每日给予150毫克。12例患者同时接受了皮质类固醇治疗。
1例患者发生了暴发性乙型肝炎，并在拉米夫定治疗开始5天后成功接受了紧急肝移植。16例患者对治疗反应良好，其生化指标迅速改善。在3 - 7个月内，15例接受调查的患者中有14例的乙肝表面抗原检测不到。其中11例在3 - 21个月内产生了保护性抗乙肝表面抗体。12例患者终止了拉米夫定治疗，仅3例患者的治疗持续超过1年。4例患者继续接受拉米夫定治疗，但治疗时间仍未超过9个月。皮质类固醇治疗是短期的；12例患者中有1例的治疗时间超过1个月。
早期单独使用拉米夫定或联合皮质类固醇治疗可能会降低重度急性乙型肝炎患者进展为暴发性肝炎的风险。
