干扰素的新组合疗法改善乙肝治疗

生物谷

        英国West  Midlands  Public  Health  Laboratory的一项新的研究显示，干扰素与脱氢皮质(甾)醇的联合使用能够改善被乙肝病毒感染的儿童的血清转化（seroconversion）时间和速度。这项研究的结果刊登在7月的Journal  of  Medical  Virology杂志上。

        由于很少能根除病毒，因此对乙肝病毒携带者治疗的首要目的是血清转化，即乙肝病毒抗原（HBeAg）阳性变为乙肝病毒e抗体（anti-HBe）阳性，或使乙肝病毒的DNA丢失。但是，目前在儿童中达到这种效果的最佳治疗方式还不清楚。

        在这项研究中，研究人员评估了接受了16周的干扰素加6周的大脱氢皮质甾醇治疗的20名儿童的长期疗效。有20名儿童只接受干扰素单独治疗；8名儿童没有接受任何治疗，即为空白对照。

        到第12个月时，研究人员对几组儿童的血清转化情况进行比较。到5年时，干扰素加脱氢皮质(甾)醇的方案比其他治疗方案的血清转化率都要高（54％），而只接受干扰素治疗的为22％，未接受治疗的为12％。研究结果显示，在3.9年时，干扰素加脱氢皮质(甾)醇疗法的血清转化达到一半，并且是几个方案中最快的。虽然，研究结果令人振奋，但是研究人员任务儿童中慢性乙肝的治疗目前还不是很理想，还需要更多来改善治疗效果．

英文原文：

　　Interferon Plus Prednisolone Improves HBV Seroconversion in Children

NEW YORK (Reuters Health) Jul 12 - Interferon therapy with prednisolone priming can improve the time and rate of seroconversion in children who have been perinatally infected with hepatitis B virus, new research shows.

Because viral eradication is seldom achieved, the primary goal for hepatitis B carriers is seroconversion, meaning that hepatitis B e antigen (HBeAg) positivity becomes hepatitis B e antibody (anti-HBe) positivity or the loss of hepatitis B DNA. The optimal therapy for achieving this outcome in children was unclear.

In the study, reported in the Journal of Medical Virology for July, Dr. Elizabeth H. Boxall, from the West Midlands Public Health Laboratory in Birmingham, UK, and colleagues assessed the long-term outcomes of 20 children treated with 16 weeks of interferon plus 6 weeks of prednisolone; 20 received interferon monotherapy; and 8 children who were not treated. The median follow-up period was 7.5 years.

At 12 months, the active interventions were comparable to no treatment in promoting seroconversion. By 5-years, however, interferon plus prednisolone provided a much higher HBeAg to anti-HBe seroconversion rate than did the other interventions -- 54% vs. 22% for interferon monotherapy and 12% for no treatment.

Seroconversion took a median of 3.9 years and was the fastest with interferon plus prednisolone, the report indicates. A pretreatment elevation in hepatic transaminases predicted a higher rate of seroconversion. Contrary to what has been seen in many European studies, none of the children in the present study cleared hepatitis B surface antigen or produced related antibodies.

"Until further antiviral agents, such as adefovir dipivoxil, have been evaluated fully, alpha interferon, including pegylated versions, with prednisolone priming should therefore still be considered in children infected perinatally with normal or low hepatic transaminases, particularly if they have an increase in hepatic amino transaminases during prednisolone priming," the authors advise.

In the meantime, they conclude that the "treatment of chronic hepatitis B in childhood remains unsatisfactory."