Schalm S W
Dept. of Internal Medicine & Hepatogastroenterology, University Hospital Dijkzigt, Rotterdam, The Netherlands.
Scand J Gastroenterol Suppl. 1990;178:111-8. doi: 10.3109/00365529009093160.
Alpha-interferon has emerged as the most effective agent for the treatment of chronic hepatitis when active replication of virus B, C, or D is present. Exogenous administration of human alpha-interferon, now possible through modern large-scale production methods, is associated with suppression of virus in blood. Amelioration of liver disease occurs in 35% of patients with hepatitis B virus and in 50% with hepatitis C virus with interferon doses of 30 and 10 MU per week, respectively, for 16-26 weeks; after therapy, persistent normalization of serum alanine aminotransferase is observed in 35% and 27%, respectively. Similar results have now also been reported for chronic hepatitis D. Enhanced response rates (greater than 50%) may be obtained by prolonged intermittent interferon therapy. Combination of interferon with another 'antiviral' agent (vidarabine, acyclovir, prednisone) has not increased therapeutic efficacy. Alpha-interferon induces side effects such as fatigue, flu-like syndrome, myalgia, and changes in mood and granulocytes. Patients with decompensated cirrhosis are particularly prone to bacterial infection and disease exacerbation and should receive lower doses. Interferon, when applied skillfully, induces the highly beneficial transition of active viral replication into viral latency, thereby greatly reducing infectivity, symptoms, and activity of the liver disease. Prevention of death from liver failure or hepatocellular carcinoma is to be expected.
当存在乙型、丙型或丁型病毒的活跃复制时，α干扰素已成为治疗慢性肝炎最有效的药物。现在通过现代大规模生产方法可以进行外源性人α干扰素给药，这与血液中病毒的抑制有关。对于分别接受每周30和10 MU干扰素治疗16 - 26周的乙型肝炎病毒患者和丙型肝炎病毒患者，分别有35%和50%的肝病得到改善；治疗后，分别有35%和27%的患者血清丙氨酸转氨酶持续正常化。慢性丁型肝炎现在也报告了类似结果。通过延长间歇干扰素治疗可获得更高的应答率（大于50%）。干扰素与另一种“抗病毒”药物（阿糖腺苷、阿昔洛韦、泼尼松）联合使用并未提高治疗效果。α干扰素会引起疲劳、流感样综合征、肌痛以及情绪和粒细胞变化等副作用。失代偿性肝硬化患者特别容易发生细菌感染和病情加重，应接受较低剂量治疗。如果巧妙应用，干扰素会促使活跃的病毒复制向病毒潜伏状态发生高度有益的转变，从而大大降低感染性、症状和肝病的活动度。有望预防因肝衰竭或肝细胞癌导致的死亡。
