Sjogren M H, Hoofnagle J H, Waggoner J G
Hepatology. 1987 May-Jun;7(3):582-5. doi: 10.1002/hep.1840070328.
Serum levels of antibody to hepatitis B core antigen and IgM antibody to hepatitis B core antigen were tested in 15 patients who participated in a randomized, placebo-controlled trial of a 28-day course of prednisolone therapy. During treatment, serum levels of antibody to hepatitis B core antigen and IgM antibody to hepatitis B core antigen decreased in all 10 treated patients, but in none of five controls (p less than 0.05). Also during therapy, ALT activity decreased by an average of 50% and serum IgG levels by 30% (both p less than 0.05). Serum levels of hepatitis B virus DNA and DNA polymerase activity did not change significantly. Four to 10 weeks after discontinuation of prednisolone, a rebound of serum ALT and IgM antibody to hepatitis B core antigen levels occurred, which usually resolved within the subsequent months of follow-up evaluation. In three patients, however, there was a prolonged exacerbation of the disease following prednisolone withdrawal; in these three, levels of IgM antibody to hepatitis B core antigen and ALT remained elevated above pretreatment values. The close correlation between changes in serum ALT activity and IgM antibody to hepatitis B core antigen levels suggests that corticosteroids can modulate disease activity in chronic type B hepatitis by suppression of the host-immune response to hepatitis B virus antigens.
对15名参与了为期28天的泼尼松龙治疗随机安慰剂对照试验的患者检测了乙型肝炎核心抗原抗体和乙型肝炎核心抗原IgM抗体的血清水平。治疗期间，所有10名接受治疗的患者血清乙型肝炎核心抗原抗体和乙型肝炎核心抗原IgM抗体水平均下降，但5名对照组患者均未下降（p<0.05）。治疗期间，ALT活性平均下降50%，血清IgG水平下降30%（均p<0.05）。血清乙型肝炎病毒DNA水平和DNA聚合酶活性无显著变化。停用泼尼松龙4至10周后，血清ALT和乙型肝炎核心抗原IgM抗体水平出现反弹，通常在随后的随访评估数月内恢复正常。然而，有3名患者在停用泼尼松龙后病情长期加重；在这3名患者中，乙型肝炎核心抗原IgM抗体和ALT水平仍高于治疗前值。血清ALT活性变化与乙型肝炎核心抗原IgM抗体水平之间的密切相关性表明，皮质类固醇可通过抑制宿主对乙型肝炎病毒抗原的免疫反应来调节慢性乙型肝炎的疾病活动。
