Guillevin L, Lhote F, Leon A, Fauvelle F, Vivitski L, Trepo C
Department of Internal Medicine, Blood Bank and Pharmacy, Bobigny, France.
J Rheumatol. 1993 Feb;20(2):289-98.
To test the effectiveness and tolerance of antiviral agents associated with short term immunosuppression in the treatment of polyarteritis nodosa (PAN) related to hepatitis B virus (HBV).
We conducted a prospective, nonblinded, multicenter trial in which patients with multisystemic PAN related to HBV were included. Every patient initially underwent a short term (2 weeks) treatment with prednisone and then received vidarabine (Vira A) and plasma exchanges. The end point of the study was control of the disease (recovery or remission) or death.
Thirty-three patients were included. Every patient had histopathologic or arteriographic evidence of vasculitis and was infected with actively replicating HBV. Disease activity during the first 6 months was controlled in 26 patients (78.8%). Among the 25 patients still alive at the end of the study, 24 (72.7%) had completely recovered with no clinical or laboratory evidence of systemic vasculitis after at least 18 months without treatment. Eight patients died during the study period; 3 of treatment failure, usually early in the course of the disease. One patient died of fulminant hepatitis 3 months after the entry in the study at time of seroconversion. The survival curve showed that at 7 years, 76% of the patients were alive. HBeAg/anti-HBeAb seroconversion was observed in 12 patients (36.3%) after one Vira A cycle. When a 2nd cycle of Vira A or alpha interferon was prescribed, HBeAg/anti-HBeAg seroconversion occurred in 15 patients (45.4%). Two other patients who underwent a 2nd cycle of Vira A administration, had lost HBeAg and no longer expressed serological evidence of replication as assessed by HBV DNA spot hybridization. At the end of the study, 17 (51.5%) no longer expressed serological evidence of HBV replication. This treatment was effective and only minor side effects were noted.
We conclude that this new therapeutic approach to PAN related to HBV effectively controlled systemic vasculitis and was associated with a higher number of recoveries from chronic HBV infections. The development of new antiviral agents, such as interferon alpha 2b, allows us to hope that antiviral therapy will have a role to play as a first line treatment regimen of virus induced vasculitis.
检测与短期免疫抑制联合使用的抗病毒药物治疗乙型肝炎病毒（HBV）相关结节性多动脉炎（PAN）的有效性和耐受性。
我们开展了一项前瞻性、非盲法、多中心试验，纳入多系统HBV相关PAN患者。每位患者最初接受泼尼松短期（2周）治疗，随后接受阿糖腺苷（Vira A）和血浆置换。研究终点为疾病控制（康复或缓解）或死亡。
纳入33例患者。每位患者均有血管炎的组织病理学或血管造影证据，且感染了活跃复制的HBV。26例患者（78.8%）在最初6个月内疾病活动得到控制。研究结束时仍存活的25例患者中，24例（72.7%）在至少18个月未治疗后完全康复，无系统性血管炎的临床或实验室证据。8例患者在研究期间死亡；3例死于治疗失败，通常在疾病早期。1例患者在研究入组3个月血清转化时死于暴发性肝炎。生存曲线显示，7年后，76%的患者存活。1个阿糖腺苷疗程后，12例患者（36.3%）出现HBeAg/抗-HBeAb血清转化。当给予第2个阿糖腺苷疗程或α干扰素时，15例患者（45.4%）出现HBeAg/抗-HBeAg血清转化。另外2例接受第2个阿糖腺苷疗程的患者，HBeAg消失，通过HBV DNA斑点杂交评估不再有复制的血清学证据。研究结束时，17例（51.5%）不再有HBV复制的血清学证据。该治疗有效，仅观察到轻微副作用。
我们得出结论，这种针对HBV相关PAN的新治疗方法有效控制了系统性血管炎，并使更多慢性HBV感染患者康复。新型抗病毒药物如α干扰素2b的研发，让我们期望抗病毒治疗能作为病毒诱导血管炎的一线治疗方案发挥作用。
