Todros L, Saracco G, Durazzo M, Abate M L, Touscoz G, Scaglione L, Verme G, Rizzetto M
Dipartimento di Gastroenterologia, Ospedale Molinette, Torino, Italy.
Hepatology. 1995 Nov;22(5):1374-8.
Interferon alfa (IFN) therapy is efficacious in chronic viral hepatitides. It may, however, cause adverse immunologic reactions in patients with concomitant autoimmune phenomena. A minority of patients with chronic type C hepatitis have antibodies against liver and kidney microsomes (anti-LKM) in serum. We therefore carried out this study to find out whether IFN is safe and efficacious also in this subgroup. We treated 92 consecutive cases of chronic hepatitis C with IFN. Twelve patients had anti-LKM< and the remaining 80 tested negative to the anti-LKM. The hepatitis C virus (HCV) infection was diagnosed on the basis of positive anti-HCV and HCV-RNA tests. We compared the clinical and virological virological results of the therapy and the side effects found in the two groups. We found that the response to therapy and the outcome after 1 year of follow-up were similar. Treatment was discontinued in one anti-LKM-positive patient because of a drastic increase in ALT levels at the fourth month of therapy. No untoward effect was observed in the other cases. Hepatitis C patients with anti-LKM may be exposed to an increased risk of an adverse hepatitic reaction while being treated with IFN. However, we found that the extent of the risk was minimal compared with the expected benefits of the therapy. IFN is therefore recommended as the first therapy to choose in these patients. They must, however, be monitored more closely for possible liver dysfunction than the ordinary hepatitis C patient.
干扰素α（IFN）疗法对慢性病毒性肝炎有效。然而，它可能会在伴有自身免疫现象的患者中引起不良免疫反应。少数慢性丙型肝炎患者血清中存在抗肝肾微粒体抗体（抗-LKM）。因此，我们开展了这项研究，以确定IFN在该亚组患者中是否安全有效。我们用IFN治疗了92例连续的慢性丙型肝炎患者。12例患者抗-LKM阳性，其余80例抗-LKM检测为阴性。丙型肝炎病毒（HCV）感染根据抗-HCV和HCV-RNA检测阳性来诊断。我们比较了两组患者治疗的临床和病毒学结果以及发现的副作用。我们发现治疗反应和随访1年后的结果相似。一名抗-LKM阳性患者在治疗第四个月时ALT水平急剧升高，因此停止了治疗。其他病例未观察到不良影响。抗-LKM的丙型肝炎患者在接受IFN治疗时可能面临肝炎不良反应风险增加的情况。然而，我们发现与治疗的预期益处相比，风险程度极小。因此，建议将IFN作为这些患者的首选治疗方法。然而，与普通丙型肝炎患者相比，必须对他们进行更密切的监测，以发现可能的肝功能障碍。
