摘要
目的我们设计拉米夫定和IFN-α序贯疗法,治疗慢性乙型肝炎患者。方法治疗组28例患者。平均年龄40岁,对照组28例患者,平均年龄40岁。治疗组单用拉米夫定100mG/d 20周,而后联合IFN-α2b 5Mu tiw和拉米夫定4周。最后单用IFN-α24周。结果 拉米夫定治疗结束时,全部血清HBVDNA转阴;序贯治疗结束后6个月,血清HBVDNA持续阴性16/28,HBeAg转为抗-HBe 10/28,HBeAg和HBsAg均出现血清学转换6/28,全部应答患者ALT复常。结论 本临床研究结果表明,拉米夫定和IFN-α序贯疗法治疗慢性乙型肝炎患者可诱导包括抗-HBs血清学转换的持续应答,此治疗方案值得在临床实践中进一步评价。
Objective Sustained viral suppression using monotherapy with interferon alfa( IFN-α) can only be achieved in a small percentage of patients with chronic hepatitis B.The concomitant administration of lamivudine and IFN-a does not enhance efficacy. We postulated that the optimal timing of therapy might be sequential treatment with lamivudine and IFN-a. The aim of this study was therefore to assess the efficacy of sequential treatment in patients resistant to IFN-α alone. Methods 28 male patients(with a median age of 40 years,nonresponders to IFN-a, with positive hepatitis B virus DNA and hepatitis B e antigen in 10 of 28 patients) were treated with lamivudine 100 mg/d alone for 20 weeks, then with both IFN-α2b 5 MU 3 times per week and lamivudine for 4 weeks,and at last with IFN-α alone for 24 weeks. Results At the end of lamivudine therapy, all patients had undetectable serum HBV DNA. Sustained serum HBV-DNA clearance 6 months after the end of sequential treatment was achieved in 16 of 28 patients, HBeAg-to-anti-HBe sero-conversion in 10 of 28 patients, and HBeAg and hepatitis B surface antigen ( HBsAg) seroconversions in 6 of 28 patients. All sustained re-sponders had normalized serum alanine transaminase( ALT) values. Conclusion The results of this pilot study suggest that sequential treatment with lamivudine and IFN-α can induce a sustained response,including HBsAg seroconversion.in patients with chronic hepatitis B not responding to IFN-α alone.This therapeutic schedule warrants further evaluation in clinical trials.
出处
《实用肝脏病杂志》
CAS
2003年第2期87-89,共3页
Journal of Practical Hepatology
