Bayraktar Y, Koseoglu T, Temizer A, Kayhan B, Van Thiel D H, Uzunalimoglu B
Department of Gastroenterology, Hacettepe University, School of Medicine, Ankara, Turkey.
J Viral Hepat. 1996 May;3(3):137-42. doi: 10.1111/j.1365-2893.1996.tb00004.x.
Unravelling the role of interferon (IFN) in the treatment of chronic hepatitis B compliance by many factors. Several mutant forms of hepatitis B virus (HBV) have recently been discovered; the most common of these is the precore mutant, characterized by hepatitis B e antigen (HBeAg) negativity and hepatitis B e antibody (HBeAb) positivity in an individual with an active HBV infection. The aim of this study was to compare the response rate to IFN therapy in patients with wild-type HBV infection and in individuals infected with the precore mutant. A second aim was to evaluate the role of an increased serum ferritin in terms of the IFN response rate in these two different types of HBV infection. IFN therapy was administered at a dose of 5 MU subcutaneously three times weekly for 6 months to 41 individuals with a chronic wild-type hepatitis B infection and 16 individuals with a precore mutant chronic HBV infection. An IFN response was defined as normalization of the serum alanine aminotransferase (ALT) level and an HBeAb to HBeAb seroconversion (in wild-type hepatitis infection), and a normalization of the serum ALT in individuals infected with a precore mutant infection. At entry, the two groups were matched for age, gender, serum ALT, serum iron, total iron binding capacity (TIBC), serum ferritin and liver histology. Forty-six per cent of the subjects with wild-type disease responded to IFN therapy. By contrast, only four of the 16 cases (25%) of the precore mutant cases responded (p < 0.05). Ferritin levels correlated well with the type of IFN response; as the serum ferritin level increased, the response rate to IFN declined. Hapatic infection caused by a precore HBV mutant is more resistant to IFN therapy than wild-type infection. The serum ferritin level appears to influence the type of IFN response achieved. Individuals with a serum ferritin level greater than 300 ng ml-1 failed to respond to IFN in 93% of the cases studied.
干扰素（IFN）在慢性乙型肝炎治疗中的作用受多种因素影响。最近发现了几种乙型肝炎病毒（HBV）的突变形式；其中最常见的是前核心突变体，其特征是在活跃的HBV感染个体中乙型肝炎e抗原（HBeAg）阴性和乙型肝炎e抗体（HBeAb）阳性。本研究的目的是比较野生型HBV感染患者和前核心突变体感染个体对IFN治疗的反应率。第二个目的是评估血清铁蛋白升高在这两种不同类型HBV感染中对IFN反应率的作用。对41例慢性野生型乙型肝炎感染个体和16例前核心突变体慢性HBV感染个体，以每周皮下注射5MU，每周3次，共6个月的剂量给予IFN治疗。IFN反应定义为血清丙氨酸氨基转移酶（ALT）水平正常化以及HBeAb到HBeAb血清学转换（在野生型肝炎感染中），以及前核心突变体感染个体的血清ALT正常化。在入组时，两组在年龄、性别、血清ALT、血清铁、总铁结合力（TIBC）、血清铁蛋白和肝脏组织学方面相匹配。野生型疾病患者中有46%对IFN治疗有反应。相比之下，16例前核心突变体病例中只有4例（25%）有反应（p<0.05）。铁蛋白水平与IFN反应类型密切相关；随着血清铁蛋白水平升高，对IFN的反应率下降。前核心HBV突变体引起的肝感染比野生型感染对IFN治疗更具抗性。血清铁蛋白水平似乎影响所实现的IFN反应类型。在所研究的病例中，血清铁蛋白水平大于300ng/ml-1的个体有93%对IFN无反应。
