干扰素联合利巴韦林治疗丙型肝炎22例临床观察

目的观察干扰素（α-2b1NF）联合利巴韦林治疗丙型肝炎的疗效。方法 治疗组应用α-2b1NF、利巴韦林口服．对照组单用α-2b1NF、均治疗24周。观察两组治疗结束及停药26周时ALT复常率、HCV—RNA阴转率。结果 治疗组ALT复常率为77．3％和72．7％．HCV-RNA阴转率为68．2％和59．0％；对照组ALT复常率为66．7％和52．4％．HCV-RNA阴转率为47．6％和28．6％．两组结果差异有统计学意义。结论 α-2b1NF联合利巴韦林治疗丙型肝炎．可提高远期疗效。     

丙型肝炎治疗中的不良反应及应对措施

口服利巴韦林联用皮下注射聚乙二醇干扰素治疗慢性丙型肝炎已成为临床标准治疗方案。然而,药物引起的相关不良反应使10％-15％的患者中断治疗。如何应对这些不良反应是每个医师关心的问题,对此本文将详细地为您作出解答。     

丙型病毒肝炎的治疗进展

长疗程干扰素治疗丙型病毒肝炎安全有效的方案，与利巴韦林合用药能进一步提高疗效。两药复合方案还可用于治疗干扰素单独治疗失败的患者。     

干扰素、利巴韦林和金刚烷胺与干扰素、利巴韦林和安慰剂对初次治疗的丙型肝炎患者的治疗对比

背景:本研究的目的是比较三联疗法(干扰素、利巴韦林和金刚烷胺)和标准疗法(干扰素、利巴韦林)对初次治疗的慢性丙型肝炎的疗效。方法:这是一个前瞻性、随机、双盲、空白对照、多中心的研究,85例患者(金刚烷胺组)给予干扰素-2b3MU每周三次,利巴韦林1000～1200mg每天,分次服用,金刚烷胺100mgBid,86例患者(空白对照组)只接受干扰素-2b、利巴韦林和相同量的安慰剂治疗。如果患者在第24周经PCR检测HCVRNA阳性则该治疗停止。所有患者在完成治疗后随访24周。初次的结束期为完成治疗后第24周检测HCV-RNA阴性。结果:在治疗结束时,金刚烷胺组…     

慢性丙型肝炎的抗病毒治疗进展

临床评价慢性丙型肝炎（ＣＨＣ）抗病毒治疗效果一般根据生化、病毒学和组织学等指标 ,如血清丙氨酸氨基转移酶（ＡＬＴ）水平、血清丙型肝炎病毒 (ＨＣＶ)ＲＮＡ负荷和肝穿刺活检得出的肝活动指数（ＨＡＩ）［１］。本文结合以上指标 ,对ＣＨＣ抗病毒治疗的有关进展作如下综述。１干扰素治疗干扰素 (ＩＦＮ)有α、β、γ３种 ,以ＩＦＮ -α临床使用资料最多。ＩＦＮ -α包括天然淋巴母细胞干扰素（ＩＦＮ -α-ｎｌ）、基因重组干扰素（ＩＦＮ -α-２ａ、ＩＦＮ -α -２ｂ、ＩＦＮ -α-１ｂ）和基因重组复合干扰素（Ｃｏｎｓｅｎｓｕｓｉｎ…     

FDA批准聚乙二醇化干扰素α—2a与利巴韦林合用治疗丙型肝炎

FDA已经批准罗氏公司的聚乙二醇化干扰素产品聚乙二醇化干扰素α 2a(peginterferonalfa 2a ,Pe gasys ,简称Peg IFNα 2a)与抗病毒药利巴韦林 (rib avirin ,Copegus)合用治疗丙型肝炎。该机构的抗病毒药顾问委员会于 2 0 0 2年 1 1月一致通过该提议。2 0 0 2年 1 0月已批准了Peg IFNα 2a的单药治疗 ,目前该产品在美国已上市。罗氏公司表示 ,利巴韦林将在 2 0 0 3年早期投放美国市场 ,但尚未定价(这两种产品将分别出售 )。目前 ,Peg IFNα 2a可单独或与利巴韦林合用治疗慢性丙型肝炎感染的成人患者 ,这些患者患有代偿性肝病 ,而且以…     

慢性乙型肝炎抗病毒治疗的进展

干扰素(Interferons)。用于病毒性肝炎治疗的主要是干扰素α，是目前国内、外公认治疗病毒性肝炎有效的药物。     

干扰素对丙型肝炎治疗的现状和展望

HCV感染的治疗目的是持久性的病毒清除，这不能仅靠单一的作用机制实现，因此需要具有不同作用模式的药物共同发挥疗效，理想情况下应改善持续性病毒应答率。     

The spectrum of hepatic functional impairment in compensated chronic hepatitis C: results from the Hepatitis C Anti-viral Long-term Treatment against Cirrhosis Trial

Background The spectrum of functional impairment in patients with compensated chronic hepatitis C is incompletely defined. Aim To define hepatic impairment by quantitative tests (quantitative liver function tests) and correlate results with disease severity in patients with chronic hepatitis C. Methods We studied 285 adult patients with chronic hepatitis C prior to treatment in the Hepatitis C Anti‐viral Long‐term Treatment against Cirrhosis Trial; 171 had Ishak fibrosis stages 2–4 (fibrosis) and 114 had stage 5 or 6 (cirrhosis). None had had clinical decompensation. A battery of 12 quantitative liver function test assessed the spectrum of hepatic microsomal, mitochondrial and cytosolic functions, and hepatic and portal blood flow. Results Twenty‐six to 63% of patients with fibrosis and 45–89% with cirrhosis had hepatic impairment by quantitative liver function test; patients with cirrhosis had the greatest impairment (P‐value ranging from 0.15 to <0.0001). Cholate Cl_oral, cholate shunt and perfused hepatic mass correlated with cirrhosis, stage of fibrosis (r = ?0.51, +0.49, ?0.51), varices and variceal size (r = ?0.39, +0.36, ?0.41). PHM < 95 and cholate shunt >35% identified 91% of patients with medium‐ or large‐sized varices. Conclusions Hepatic impairment is common in compensated patients with fibrosis or cirrhosis because of chronic hepatitis C. Cholate shunt, and cholate Cl_oral and perfused hepatic mass, identify patients at risk for cirrhosis or varices.     

Comparison among Different Types, Dosages and Duration of Interferon Therapy in Chronic Hepatitis C

In an attempt to determine the best therapeutic protocol for the treatment of chronic hepatitis C with interferon (IFN), we reported our experience comparing the efficacy of IFN at the usual dose and duration, i.e. 3 million units (MU) three times weekly for 6 months, with the immediate and long-term effects of different types, dosages and duration of IFN therapy. 300 patients with chronic hepatitis C were randomly assigned to five groups of 60 subjects each and treated as follows: group A - recombinant IFN alpha (rIFNalpha) 3MU three times weekly for 6 months; group B - rIFNalpha 6MU three times weekly for 6 months; group C - rIFNalpha 3MU 3 times weekly for 12 months; group D - lymphoblastoid IFN (L-IFN) 6MU three times weekly for 6 months; group E - L-IFN 3MU three times weekly for 12 months. The diagnosis of hepatitis was based on clinical, serological and histological data in all patients. A 'biochemical response' was defined as the normalisation of alanine aminotransferase (ALT) values, and a 'complete response' as the normalisation of ALT with disappearance of serum hepatitis C virus (HCV)-RNA. A 'sustained response' was defined as the persistence of ALT normalisation and undetectable viraemia 2 years after the end of treatment. The five groups were homogeneous. The incidence of dropouts was 8%, and IFN treatment was interrupted for adverse effects in 11% of the patients. In group A, 55% of the patients showed a 'biochemical response' and 31% of the subjects demonstrated a 'complete response'. In group B, a 'biochemical response' was observed in 61% and a 'complete response' in 36% of the cases. In group C, 77% of the subjects showed a 'biochemical response', with a 'complete response' seen in 40%. In group D, we observed a 'biochemical response' in 55% of the patients and a 'complete response' in 33%. In group E, 79% of the subjects had a 'biochemical response', and a 'complete response' was seen in 38%. At the end of the treatment-free follow-up the percentage of patients with a sustained response was 24% in group A, 28% in group B, 35% in group C, 27% in group D and 33% in group E. Therefore, a longer period of IFN treatment seems to provide higher percentages of sustained response than the usual 6-month duration, independently of the type of IFN. Moreover, the patients treated with a higher dosage (6MU 3 times weekly) for 6 months showed a slightly better sustained response rate compared with the usual dose. In conclusion, even if the differences among the response rates in the five groups were not statistically significant, we recommend a 12-month regimen, possibly using higher dosages at least in the first 4 to 6 months of treatment.     

恩替卡韦对初期治疗不同时期乙肝肝硬化患者抗病毒的疗效评价

目的:评价恩替卡韦对初期治疗代偿期和失代偿期乙肝肝硬化患者抗病毒的疗效。方法:选取2014年9月—2015年9月间收治的代偿期和失代偿期乙肝肝硬化患者85例;将其分为恩替卡韦初治代偿期组(45例)和失代偿期组(40例);比较两组患者治疗前后AST、ALT、TBi L、ALB以及CHE等指标变化情况。结果:治疗后代偿组患者ALT为(35.33±5.89)U/L,AST为(41.29±15.29)U/L,TBi L为(21.34±11.87)μmol/L;而失代偿组患者分别为(74.03±10.97)U/L,(97.21±20.08)U/L和(49.04±12.65)μmol/L(P<0.05);治疗后代偿组患者ALB为(44.21±5.31)g/L,CHE为(5 445.98±762.19)U/L,失代偿组分别为(31.23±3.09)g/L和(3 219.03±983.21)U/L(P<0.05);代偿组治疗后ChildPugh评分值为(5.17±1.02)分和HBV-DNA阴转率为91.11%优于失代偿组为(8.97±1.03)分和HBV-DNA阴转率为82.50%(P<0.05)。结论:采用恩替卡韦初治乙肝肝硬化患者,其代偿期的疗效优于失代偿组。     

HCV和输血后非甲非乙型肝炎

以抗-HCV(C-100)为诊断HCV感染的血清学方法的检测表明,92例输血后非甲非乙型肝炎(PTNANBH)阳性率为69.6％,而非输血后NANBH仅为3.5％(4/113)。92例PTNANBH中,急性、慢性患者抗-HCV检出阳性率分别为56.6％(30/53),87.1％(34/39)。上述结果提示,抗-HCV测定对PTNANBH具有重要诊断意义,HCV是引起PTNANBH的主要病原,HCV感染易于导致慢性肝炎。     

病毒性肝炎的基因治疗现况

病毒性肝炎是严重危害人类健康的常见传染病，全球约有5亿慢性乙型肝炎病毒(HBV)和丙型肝炎病毒(HCV)感染者，并且与肝硬化和肝细胞癌的发生密切相关。目前，尚缺乏有力的抗肝炎病毒治疗药物。尽管近年干扰素和抗病毒核苷类药物不断有新的进展，但疗效不尽人意。随着分子生物学技术的发展和人类基因组计划的完成，基因治疗的领域不断拓展，抗肝炎病毒的基因治疗已成为基因疗法的一个重要分支并显示出可喜苗头。所谓基因治疗指用正常的野生型基因或特定设计的治疗基因导入机体或特定的细胞内替代、修正、补偿有缺陷的基因功能；或封闭、抑制异常表达的基因以达到治疗某种疾病的目的。