α-干扰素联合拉米夫定治疗慢性乙型肝炎的Th1/Th2应答

目的了解α-干扰素和拉米夫定联合治疗慢性乙型肝炎的短期效果,以及对两种辅助性T细胞(Th1/Th2)细胞因子的表达水平的影响。方法71例HbeAg阳性的慢性乙型肝炎患者随机分成治疗组与对照组。治疗组34例,同时使用α-干扰素和拉米夫定26周,随后单用拉米夫定26周;对照组37例,单用拉米夫定52周。观察其血清生化指标、病毒复制指标及外周血淋巴(PBMC)培养上清液的IFN-γ、IL-4水平。结果两组完全应答率无显著性差异(p=0.08)。两组在治疗3个月时IFN-γ水平均有明显上升(p=0.02,0.01),在治疗6个月时对照组IFN-γ水平明显下降(p=0.03),低于治疗组(p=0.04)。治疗组IL-4水平在第3、6个月明显降低(p=0.01,0.02),而对照组IL-4水平虽有所下降,但差异无统计学意义(p=0.23,0.09)。组间比较发现,两组治疗前、治疗3个月、6个月IL-4水平无差别(p=0.18,0.58,0.14)。结论α-干扰素与拉米夫定联合用药与单用拉米夫定短期疗效并无显著性差异,但联合用药所诱导机体产生的HBV特异性CTL反应较单用拉米夫定更强且持久,提示两组的远期疗效可能会出现差异。

Th1/Th2 response in alpha interferon and Iamivudine combination treatment of patients with chronic hepatitis B infection

Objective To evaluate the efficacy of 1 year treatment of interferon combined with lamivudine therapy in chronic hepatitis B patients. Methods 71 patients were enrolled and randomized into two groups. 34 patients received interferon alpha and lamivudine simultaneously for 26 weeks, then lamivudine alone for another 26 weeks. 37 patients received lamivudine alone for 52 weeks. The efficacy was evaluated by biochemical and virological parameters. The Th1/Th2 type cytokines in the supernatant of peripheral blood mononuclear cells(PBMC) cultures were detected by ELISA. Results proportion of HbeAg/Anti-HBe seroconversion in combination group was higher than lamivudine group(41.2% vs 21.6%) with no significance (p=0.08). Conclusions The short term efficacy of combination therapy showed no significant difference with lamivudine therpyt. Cytokines measurements showed more active and sustained T helper cell response in combination group during treatment, which indicate that the long term efficacy may be different.