Alscher D M, Bode J C
Zentrum für Innere Medizin, Robert-Bosch-Krankenhaus, Stuttgart.
Med Klin (Munich). 1997 Mar 15;92(3):147-61. doi: 10.1007/BF03043273.
The purpose of this review is an update of the therapy of hepatitis C especially with Interferon-alpha. From the large number of publications on this topic the established facts were worked out. Taking these facts as a base guidelines for the therapy in practical use were defined. In addition the aspects of therapeutic strategies of chronic hepatitis C which until now can not definitely be judged are discussed. In the relatively few patients in whom hepatitis C is diagnosed already in the acute phase, Interferon-alpha-treatment (3 x 3 million units 3 times a week) for 3 to 4 months increases the percentage of patients in whom HCV-RNA in the serum is eliminated. In patients with chronic hepatitis C, after decision finding for treatment, a standard scheme is recommended which consists of a monotherapy with recombinant Interferon-alpha. The dosage of Interferon-alpha is in the first 12 to 16 weeks 5 up to 6 million units given 3 times a week. For the further therapy 3 million units 3 times a week seems to be appropriate. The recommended duration of Interferon-alpha-therapy is 12 months. A long-term benefit of about 20% can be achieved in unselected groups of patients when judged on the permanent normalisation of serum transaminases and elimination of HCV-RNA in the serum. Important factors which may influence the probability of a sustained response, like HCV genotype, virus titer in serum, duration of the disease, high hepatic iron content and the presence of cirrhosis, are discussed. Up to now there exist no reliable guidelines in the case of a "no change" situation and for patients with a flare-up of inflammatory activity during or after therapy. Combination therapy of Interferon-alpha with other drugs like analogous of nucleotides (for example ribavarin), non steroidal antirheumatic drugs and ursodesoxycholic acid (UDCA) have still to be evaluated in controlled clinical trials.
本综述的目的是更新丙型肝炎的治疗方法，尤其是关于α干扰素的治疗。从大量关于该主题的出版物中梳理出已确定的事实。以这些事实为基础，确定了实际应用中的治疗指南。此外，还讨论了目前尚无法明确判断的慢性丙型肝炎治疗策略的相关方面。在相对较少的急性期就已诊断出丙型肝炎的患者中，采用α干扰素治疗（每周3次，每次300万单位）3至4个月可提高血清中丙型肝炎病毒核糖核酸（HCV-RNA）被清除的患者比例。对于慢性丙型肝炎患者，在决定进行治疗后，推荐一种标准方案，即采用重组α干扰素单药治疗。α干扰素的剂量在最初12至16周为每周3次，每次500万至600万单位。后续治疗阶段，每周3次，每次300万单位似乎较为合适。推荐的α干扰素治疗疗程为12个月。从不特定的患者群体来看，根据血清转氨酶持续正常以及血清中HCV-RNA被清除来判断，可实现约20%的长期获益。文中讨论了可能影响持续应答概率的重要因素，如HCV基因型、血清病毒滴度、病程、肝脏铁含量高以及肝硬化的存在。到目前为止，对于治疗期间或治疗后出现“无变化”情况以及炎症活动突然加剧的患者，尚无可靠的指导原则。α干扰素与其他药物如核苷酸类似物（如利巴韦林）、非甾体类抗风湿药物及熊去氧胆酸（UDCA）的联合治疗仍有待在对照临床试验中进行评估。
