Woo M H, Burnakis T G
Pharmaceutical Department, St Jude's Children's Research Hospital, Memphis, TN, USA.
Ann Pharmacother. 1997 Mar;31(3):330-7. doi: 10.1177/106002809703100312.
To review the indications, efficacy, and toxicity of interferon alfa in the treatment of chronic hepatitis B and C.
English-language literature pertaining to chronic hepatitis B and C and their management with interferon reported between 1980 and June 1995 was identified through computer searches using MEDLINE and through extensive searching of bibliographies and identified articles.
Two major causes of chronic hepatitis are hepatitis B virus and hepatitis C virus (HBV and HCV). Worldwide, HBV infection is a major cause of cirrhosis and hepatocellular carcinoma, but in the US it is mainly a disease of high-risk groups. In the US, and particularly the southern portion, HCV is more common. Like HBV, HCV also may cause cirrhosis and hepatocellular carcinoma. Except for interferon therapy, the ability to effectively treat chronic hepatitis is limited. Interferon has antiviral, antiproliferative, and immunomodulatory activity. This agent is indicated in patients who have histologic evidence of chronic hepatitis and ongoing viral replication. Thirty percent to 40% of patients with HBV achieve loss of serum HBV e antigen and HBV DNA after treatment with interferon alfa 5 million units/d or 10 million units three times weekly for 16 weeks. Fifty percent of patients with chronic HCV respond to interferon 3 million units three times weekly for 6 months, but half of these relapse within the next 6 months. Prolonged use (18 months) may provide longer term responses in HCV. Adverse effects are common, often dose-dependent, and usually transient. A flu-like syndrome occurs early in the treatment, but fatigue is the most common adverse effect and persists throughout therapy. Long-term interferon treatment has not been extensively evaluated and the impact on survival rates is not known.
Interferon is the only agent to have shown a consistent therapeutic effect on chronic hepatitis. Response of HBV to interferon is usually sustained, while a recurrence of HCV occurs in 50% of those who initially respond. Despite the benefits of interferon, its adverse effects and impact on hepatitis must be considered before treatment can be freely advocated.
回顾干扰素α治疗慢性乙型肝炎和丙型肝炎的适应证、疗效及毒性。
通过使用MEDLINE进行计算机检索，以及广泛查阅参考文献和已识别文章，确定了1980年至1995年6月间发表的有关慢性乙型肝炎和丙型肝炎及其干扰素治疗的英文文献。
慢性肝炎的两个主要病因是乙型肝炎病毒和丙型肝炎病毒（HBV和HCV）。在全球范围内，HBV感染是肝硬化和肝细胞癌的主要病因，但在美国，它主要是高危人群的疾病。在美国，尤其是南部地区，HCV更为常见。与HBV一样，HCV也可能导致肝硬化和肝细胞癌。除干扰素治疗外，有效治疗慢性肝炎的能力有限。干扰素具有抗病毒、抗增殖和免疫调节活性。该药物适用于有慢性肝炎组织学证据且病毒持续复制的患者。用500万单位/天的干扰素α或每周3次、每次1000万单位，治疗16周后，30%至40%的HBV患者血清HBV e抗原和HBV DNA转阴。50%的慢性HCV患者对每周3次、每次300万单位的干扰素治疗6个月有反应，但其中一半在接下来的6个月内复发。延长疗程（18个月）可能使HCV患者获得更长期的反应。不良反应常见，通常与剂量相关，且多为短暂性。治疗早期会出现流感样综合征，但疲劳是最常见的不良反应，且在整个治疗过程中持续存在。长期干扰素治疗尚未得到广泛评估，其对生存率的影响尚不清楚。
干扰素是唯一对慢性肝炎显示出持续治疗效果的药物。HBV对干扰素的反应通常是持续的，而最初有反应的HCV患者中50%会复发。尽管干扰素有诸多益处，但在大力提倡使用之前，必须考虑其不良反应及对肝炎的影响。
