Brunetto M R, Oliveri F, Colombatto P, Capalbo M, Barbera C, Bonino F
Department of Gastroenterology, Molinette Hospital, Turin, Italy.
J Hepatol. 1995;22(1 Suppl):42-4.
We studied the prevalence of long-term responders to interferon-alpha (IFN-alpha) treatment (undetectable levels of serum IgM anti-HBc, HBV-DNA and normal ALT values for 3 years) in 53 anti-HBe-positive chronic hepatitis B patients. Forty-two of them were treated with (6-18 MU) alpha-2a-recombinant-IFN t.w. for 4-6 months, and the remaining 11 with 10 MU of lymphoblastoid-IFN thrice weekly for 6 months. At the end of treatment, HBV-DNA levels were undetectable and ALT values within the normal range in 34 of 53 patients (60%); IgM anti-HBc levels decreased in all the 34 patients, falling below 10 PEI U in 2/34 (6%). Response to treatment was maintained throughout the follow-up (mean 3 years, range 2-7 years) in five patients (9.4%). The remaining 29 patients experienced HBV reactivation within median follow-up of 6 months (range 1-22 months; 90% of cases within 12 months). Overall 4/9 long-term responders (44.4%) cleared serum HBsAg. In conclusion, chronic anti-HBe-positive hepatitis B has a lower IFN treatment response rate than the HBeAg-positive form; however, among long-term responders, the incidence of serum HBsAg clearance is comparable in the two forms. Because of the high rate of relapses, stringent monitoring criteria (HBV-DNA, IgM anti-HBc and ALT monthly tested for at least 12 months) are mandatory.
我们研究了53例抗-HBe阳性慢性乙型肝炎患者中，对干扰素-α（IFN-α）治疗产生长期应答者（血清IgM抗-HBc、HBV-DNA水平检测不到且ALT值正常达3年）的比例。其中42例患者接受α-2a重组IFN（6 - 18 MU）皮下注射，每周3次，共治疗4 - 6个月；其余11例患者接受淋巴母细胞IFN 10 MU，每周3次，共治疗6个月。治疗结束时，53例患者中有34例（60%）HBV-DNA水平检测不到且ALT值在正常范围内；所有34例患者的IgM抗-HBc水平均下降，其中2/34例（6%）降至10 PEI U以下。5例患者（9.4%）在整个随访期（平均3年，范围2 - 7年）内维持治疗应答。其余29例患者在中位随访期6个月（范围1 - 22个月；90%的病例在12个月内）出现HBV再激活。总体而言，9例长期应答者中有4例（44.4%）清除了血清HBsAg。总之，抗-HBe阳性慢性乙型肝炎的IFN治疗应答率低于HBeAg阳性型；然而，在长期应答者中，两种类型的血清HBsAg清除率相当。由于复发率高，必须采用严格的监测标准（至少12个月每月检测HBV-DNA、IgM抗-HBc和ALT）。
