Alexander G J, Fagan E A, Hegarty J E, Rolando N, Guarner P, Eddleston A L, Williams R
J Hepatol. 1986;3 Suppl 2:S123-7. doi: 10.1016/s0168-8278(86)80110-6.
Histological remission is recognised to follow loss of viral replication in chronic hepatitis B virus infection. The aim of antiviral therapies has been to accelerate seroconversion from HBeAg to anti-HBe, but so far none has been shown to be of significant advantage in adequate, controlled trials and toxicity has been common. A randomised controlled trial of acyclovir, 45 mg/kg/day by continuous intravenous infusion for 28 days versus no therapy has been completed in 30 patients positive for HBsAg and HBeAg for a minimum of 6 months. Patients were stratified for sex, histology and homosexual activity. Twenty-eight days therapy was associated with only a modest reduction in serum markers of viral replication. At 12-months DNAp was lost in 5/15 treated and 2/11 of the untreated group, while of the latter, 2 patients initially negative became positive. Seroconversion from HBeAg to anti-HBe had occurred in 4 of 15 treated and 1 of 15 untreated patients (95% confidence limits 12% and 51%) and was associated with histological improvement. Acyclovir had only a weak effect on viral replication and did not significantly accelerate the rate of seroconversion to anti-HBe.
在慢性乙型肝炎病毒感染中，组织学缓解被认为是随着病毒复制的消失而出现的。抗病毒治疗的目的是加速从HBeAg到抗-HBe的血清学转换，但到目前为止，在充分的对照试验中，没有一种治疗方法显示出显著优势，而且毒性很常见。一项关于阿昔洛韦的随机对照试验已经完成，该试验将30例HBsAg和HBeAg阳性至少6个月的患者分为两组，一组每天以45mg/kg的剂量持续静脉输注阿昔洛韦28天，另一组不接受治疗。患者按性别、组织学和同性恋活动进行分层。28天的治疗仅使病毒复制的血清标志物略有下降。在12个月时，治疗组15例中有5例DNAp消失，未治疗组11例中有2例消失，而在未治疗组中，最初阴性的2例患者转为阳性。治疗组15例中有4例、未治疗组15例中有1例发生了从HBeAg到抗-HBe的血清学转换（95%置信区间为12%和51%），且与组织学改善相关。阿昔洛韦对病毒复制的作用较弱，并未显著加速抗-HBe的血清学转换率。
