Liaw Y F
Liver Research Unit, Chang Gung Memorial Hospital and Medical College, Taipei, Taiwan.
J Gastroenterol Hepatol. 1998 Jan;13(1):14-20. doi: 10.1111/j.1440-1746.1998.tb00539.x.
Clinical and experimental studies have shown that T cell-mediated immune mechanisms are involved in the pathogenesis of hepatitis B virus (HBV) and hepatitis C virus infection. Immunosuppressants may impair T cell function and thereby reduce immune-mediated hepatocytolysis and virus clearance. In addition, corticosteroid may activate the glucocorticoid responsive element in the HBV genome to enhance HBV replication and gene expression. These combined effects result in an increase of viraemia in association with a decrease of serum aminotransferase and hepatic necroinflammation. In acute infection, use of immunosuppressants will increase the incidence of chronic evolution. In chronic infection, withdrawal of immunosuppressants will be followed by a clinical flare due to a rebound of immune attack to hepatocytes with increased viral load. This may lead to a subsequent decrease of the viraemia. Therefore, short-term use of immunosuppressant before antiviral therapy may be beneficial in the treatment of chronic viral hepatitis. However, the clinical rebound may be extremely severe and lead to hepatitis failure; thus, the patients should be monitored closely upon tapering and after the withdrawal of immunosuppressants. Long-term use of immunosuppressants in patients with hepatitis virus infection is usually deleterious, particularly in patients after organ transplantation. These findings suggest that clinicians should be cautious in the use of immunosuppressants in patients with hepatitis virus infection.
临床和实验研究表明，T细胞介导的免疫机制参与了乙型肝炎病毒（HBV）和丙型肝炎病毒感染的发病过程。免疫抑制剂可能损害T细胞功能，从而减少免疫介导的肝细胞溶解和病毒清除。此外，皮质类固醇可能激活HBV基因组中的糖皮质激素反应元件，以增强HBV复制和基因表达。这些综合作用导致病毒血症增加，同时血清转氨酶和肝脏坏死性炎症减少。在急性感染中，使用免疫抑制剂会增加慢性化的发生率。在慢性感染中，停用免疫抑制剂后，由于对病毒载量增加的肝细胞的免疫攻击反弹，会出现临床病情恶化。这可能导致随后病毒血症的下降。因此，在抗病毒治疗前短期使用免疫抑制剂可能对慢性病毒性肝炎的治疗有益。然而，临床病情反弹可能极其严重并导致肝衰竭；因此，在逐渐减量和停用免疫抑制剂后，应对患者进行密切监测。在肝炎病毒感染患者中长期使用免疫抑制剂通常是有害的，尤其是在器官移植后的患者中。这些发现表明，临床医生在肝炎病毒感染患者中使用免疫抑制剂时应谨慎。
