Kakumu S, Yoshioka K, Wakita T, Ishikawa T, Takayanagi M, Higashi Y
Third Department of Internal Medicine, Nagoya University School of Medicine, Japan.
Gastroenterology. 1993 Aug;105(2):507-12. doi: 10.1016/0016-5085(93)90727-t.
Chronic hepatitis C is a common and often progressive liver disease for which interferon alfa therapy widely spreads, but the beneficial response is frequently transient. Ribavirin is a nucleoside analog with a broad spectrum of antiviral action, and we investigated the efficacy of it in patients with chronic active hepatitis C.
We conducted a pilot study of oral ribavirin in patients with chronic active hepatitis C. Twenty-seven patients with hepatitis C virus RNA were randomly assigned to receive either 0.8-1.0 g of ribavirin daily or 3 MU of interferon beta three times weekly or combination of the two for 24 weeks.
Ribavirin was tolerated well, and all completed the treatment schedule. Ribavirin decreased aminotransferase levels in all instances, and the mean value at termination decreased to half of the baseline level (P < 0.01), but the enzyme level increased after cessation of therapy in most cases. Ribavirin suppressed amounts of hepatitis C virus RNA in 4 of 9 patients, and 1 became negative during follow-up. Interferon alone (P < 0.05) or with ribavirin (P < 0.01) significantly decreased the viral population, resulting in sustained loss of viremia with normal enzyme levels in 2 of 9 and 3 of 9 patients, respectively, in each therapy during follow-up.
These results indicate that ribavirin has a beneficial effect in some patients with chronic hepatitis C, although the antiviral effect is less than interferon beta. Large-scale trials are needed to determine whether the combination of interferon and ribavirin is of more benefit than interferon alone.
慢性丙型肝炎是一种常见且通常会进展的肝脏疾病，干扰素α疗法在该病中广泛应用，但有益反应往往是短暂的。利巴韦林是一种具有广泛抗病毒作用的核苷类似物，我们研究了其对慢性活动性丙型肝炎患者的疗效。
我们对慢性活动性丙型肝炎患者进行了口服利巴韦林的初步研究。27例丙型肝炎病毒RNA阳性患者被随机分配，分别接受每日0.8 - 1.0克利巴韦林、每周三次每次300万单位干扰素β或两者联合治疗，疗程为24周。
利巴韦林耐受性良好，所有患者均完成治疗方案。利巴韦林在所有情况下均降低了转氨酶水平，治疗结束时的平均值降至基线水平的一半（P < 0.01），但在大多数情况下，停药后酶水平升高。利巴韦林使9例患者中的4例丙型肝炎病毒RNA量减少，1例在随访期间转为阴性。单独使用干扰素（P < 0.05）或与利巴韦林联合使用（P < 0.01）均显著降低了病毒载量，在随访期间每种治疗中分别有9例患者中的2例和9例患者中的3例实现了病毒血症持续消失且酶水平正常。
这些结果表明，利巴韦林对一些慢性丙型肝炎患者有有益作用，尽管其抗病毒作用小于干扰素β。需要进行大规模试验以确定干扰素和利巴韦林联合使用是否比单独使用干扰素更有益。
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