Hoofnagle J H
Division of Digestive Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892.
J Hepatol. 1990;11 Suppl 1:S100-7. doi: 10.1016/0168-8278(90)90173-o.
Antiviral therapy for chronic hepatitis B is still experimental. Recent studies suggest that a 3- to 6-month course of alpha-interferon in doses ranging from 5-10 million units (5 million units/m2) given daily or three times weekly will result in a clinical, biochemical and serological remission in 30-40% of patients with well compensated liver disease and with hepatitis B virus DNA and hepatitis B e antigen in serum. Features that predict a beneficial response to treatment include high initial serum aminotransferase activities and low levels of circulating viral DNA. Asian patients and children may be less likely to respond to treatment than Caucasian adults. Pre-treatment of patients with a 6-week course of high doses of prednisone may help to increase the response rate to alpha-interferon alone, but this approach should be used only in patients with mild disease and perhaps in patients who have previously failed to respond to alpha-interferon alone. The best approach to treatment of patients with complications of chronic hepatitis B and atypical serological patterns is still uncertain. The efficacy and the side effects of alpha-interferon therapy should be carefully balanced in the decision to treat patients with chronic hepatitis B. Future studies should focus upon the use of newer antiviral agents alone or in combination with alpha-interferon.
慢性乙型肝炎的抗病毒治疗仍处于试验阶段。最近的研究表明，对于病情得到良好控制、血清中存在乙肝病毒DNA和乙肝e抗原的患者，给予剂量为500万至1000万单位（500万单位/平方米）的α干扰素，每日一次或每周三次，进行3至6个月的疗程，30%至40%的患者会出现临床、生化和血清学缓解。预测治疗有效反应的特征包括初始血清转氨酶活性高和循环病毒DNA水平低。亚洲患者和儿童对治疗的反应可能不如白人成年人。对患者进行为期6周的高剂量泼尼松预处理可能有助于提高单独使用α干扰素的反应率，但这种方法仅应在病情较轻的患者中使用，或许也可用于先前单独使用α干扰素无效的患者。对于患有慢性乙型肝炎并发症和非典型血清学模式的患者，最佳治疗方法仍不确定。在决定治疗慢性乙型肝炎患者时，应仔细权衡α干扰素治疗的疗效和副作用。未来的研究应侧重于单独使用新型抗病毒药物或与α干扰素联合使用。
