恩替卡韦与早期皮质类固醇联合治疗慢性乙型肝炎重度加重期
A combination treatment of entecavir and early-phase corticosteroid in severe exacerbation of chronic hepatitis B.
作者信息
Matsumoto Kazuyuki, Miyake Yasuhiro, Miyatake Hirokazu, Takahara Masahiro, Imada Takayuki, Yagi Satoru, Toyokawa Tatsuya, Nakatsu Morihito, Ando Masaharu, Hirohata Mamoru
机构信息
Department of Internal Medicine, Mitoyo General Hospital, Kanonji, Japan.
出版信息
World J Gastroenterol. 2009 Apr 7;15(13):1650-2. doi: 10.3748/wjg.15.1650.
Of patients with severe exacerbation of chronic hepatitis B accompanied by jaundice and coagulopathy, 20%-30% have a fatal outcome. In this report, we describe 2 cases of severe exacerbation of chronic hepatitis B with jaundice and coagulopathy who were successfully treated with a combination of entecavir and corticosteroid. In both cases, rapid reductions in serum hepatitis B virus (HBV)-DNA levels were observed, and corticosteroid was stopped after serum HBV-DNA levels became undetectable. Entecavir treatment was continued. Generally, entecavir treatment reduced serum HBV-DNA levels rapidly, although the improvement in liver function was delayed by a few weeks. During this time lag, liver cell injury continued and the disease progressed. Corticosteroid suppressed the excessive host immune response and was useful for stopping progressive deterioration. A combination of entecavir and early-phase corticosteroid may be a useful treatment in severe exacerbation of chronic hepatitis B.
伴有黄疸和凝血功能障碍的慢性乙型肝炎重度恶化患者中，20%-30%会有致命结局。在本报告中，我们描述了2例伴有黄疸和凝血功能障碍的慢性乙型肝炎重度恶化患者，他们接受恩替卡韦和皮质类固醇联合治疗后获得成功。在这两个病例中，均观察到血清乙型肝炎病毒（HBV）-DNA水平迅速下降，血清HBV-DNA水平变得不可检测后停用皮质类固醇。继续进行恩替卡韦治疗。一般来说，恩替卡韦治疗可迅速降低血清HBV-DNA水平，尽管肝功能改善延迟了几周。在此时间间隔内，肝细胞损伤持续，疾病进展。皮质类固醇抑制了过度的宿主免疫反应，有助于阻止病情的进行性恶化。恩替卡韦和早期皮质类固醇联合使用可能是慢性乙型肝炎重度恶化的一种有效治疗方法。
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