Guan R, Ho K Y, Yap I, Kang J Y, Tan C C, Ng C, Smith R, Wee A
Department of Medicine and Pathology, National University of Singapore.
Aliment Pharmacol Ther. 1995 Oct;9(5):535-40. doi: 10.1111/j.1365-2036.1995.tb00417.x.
Alpha-interferon has been found to inhibit hepatitis B virus (HBV) replication in Chinese patients with chronic HBV infection although a sustained effect was rarely achieved in those with normal pretreatment serum alanine amino transferase (ALT) levels. Prednisolone priming has been found to be beneficial over treatment with interferon alone in these subjects. We studied the effect of steroid pre-treatment followed by recombinant interferon alpha-2a in the treatment of asymptomatic HBV carriers with positive hepatitis Be antigen (HBeAg), hepatitis B viral DNA (HBV-DNA) and minimal changes in liver histology.
The treatment regimen included a 6-week prednisolone priming, a 2 week rest followed by 14 weeks of three times weekly 9 mega units of interferon alpha-2a injection and 52 weeks of follow-up. There were seven patients in the treatment group and seven controls.
The mean age, pre-treatment ALT (normal in all except for one in each of the treatment and control groups), HBV-DNA levels and histological scores were similar in the two groups. Serum HBV-DNA levels fell in six patients during treatment and became undetectable in two of them by the end. During follow-up, serum HBV-DNA returned to pre-treatment levels in all patients. None of the treated patients had HBeAg sero-conversion and none of the controls had spontaneous clearance of HBV-DNA or sero-conversion of HBeAg. No improvement of liver histology was observed in any of the treated patients. There were only mild flu-like side-effects noted and interferon alpha-2a was well tolerated at the doses given among treated patients.
Prednisolone priming followed by interferon alpha-2a treatment has no beneficial effect on HBV carriers in the early stages of chronic hepatitis B infection.
已发现α干扰素可抑制慢性乙型肝炎病毒（HBV）感染中国患者体内的HBV复制，尽管对于治疗前血清丙氨酸氨基转移酶（ALT）水平正常的患者很少能实现持续疗效。已发现泼尼松龙预处理对这些受试者比单独使用干扰素治疗更有益。我们研究了类固醇预处理后使用重组α-2a干扰素治疗无症状HBeAg阳性、HBV-DNA阳性且肝脏组织学变化轻微的HBV携带者的效果。
治疗方案包括6周的泼尼松龙预处理、2周的休息，随后是14周每周三次注射9百万单位的α-2a干扰素以及52周的随访。治疗组有7名患者，7名对照。
两组的平均年龄、治疗前ALT（治疗组和对照组各有1例异常，其余均正常）、HBV-DNA水平和组织学评分相似。6例患者治疗期间血清HBV-DNA水平下降，其中2例最终检测不到。随访期间，所有患者血清HBV-DNA恢复到治疗前水平。治疗患者中无一例发生HBeAg血清学转换，对照组中无一例出现HBV-DNA自发清除或HBeAg血清学转换。治疗患者中未观察到肝脏组织学改善。仅记录到轻微的流感样副作用，治疗患者给予的剂量下α-2a耐受性良好。
泼尼松龙预处理后使用α-2a干扰素治疗对慢性乙型肝炎感染早期的HBV携带者无有益效果。
