病毒性肝炎患者α干扰素中和抗体的发生率及其意义

目的：探讨α干扰素（ＩＦＮα）中和抗体产生的规律及其意义。方法：采用抗病毒中和生物测定法检测３２例健康人和１１６例ＩＦＮα治疗的慢性肝炎患者血清中的ＩＦＮα的中和抗体（ＮＡ）。结果：健康人及ＩＦＮα治疗前的患者均未检出ＮＡ。治疗后共２０例（１７２％）阳性，其中４例是在治疗后第２个月检出，２０例第６个月全部阳性，ＩＦＮ－α２ａ、ＩＦＮ－α２ｂ、ＩＦＮ－α１ｂ治疗组的ＮＡ阳性率分别为３４６％、１３２％、１１５％。ＮＡ阳性组、ＮＡ高滴度组的病毒清除率显著低于ＮＡ阴性组、ＮＡ低滴度组（Ｐ＜００１），相反病毒复发率在ＮＡ阳性组显著高于ＮＡ阴性组（Ｐ＜００５）。治疗前ＡＬＴ高水平组的ＮＡ阳性率显著低于ＡＬＴ低水平组（Ｐ＜００５），而前者的病毒阴转率显著高于后者（Ｐ＜００５）。结论：提示ＩＦＮα治疗后ＮＡ发生率较低，其产生有一定的时间规律。ＮＡ可影响治疗效果，对治疗前ＡＬＴ水平的了解有助于病例的选择     

病毒性肝炎患者IL－1、IL－6和TNFα活性的检测

检测了甲、乙型病毒性肝炎患者外周血单个核细胞（ＰＢＭＣｓ）ＩＬ－１、ＩＬ－６和ＴＮＦα的诱生活性及其血清中活性。结果表明，乙型慢性活动性肝炎（ＣＡＨ）、乙型肝炎后肝硬化（ＨＣ）和乙型重型肝炎（ＳＨ）ＰＢＭＣｓ经脂多糖诱导后，ＩＬ－１活性分别为３５３１．１±８８２．７Ｕ／ｍ１、２７６９．７±７３０．４±Ｕ／ｍｌ和５３２９．３±１０８９．３Ｕ／ｍｌ，高于正常对照组（Ｐ＜０．０５或（０．０１）；ＩＬ－６诱生活性分别为３８．９０±１４．７５Ｕ／ｍ１、２．４５±１８．８５Ｕ／ｍｌ和７１．９５±２８．０５Ｕ／ｍｌ（与正常对照组相比，ｐ＜０．０５或＜０．０１）；ＴＮＦα诱生活性在乙型慢性迁延性肝炎（ＣＰＨ）、ＣＡＨ、ＨＣ和ＳＨ中分别为３３．２３±７．２５Ｕ／ｍｌ、６．９９±１．８４Ｕ／ｍ１、４．２９±２．１７Ｕ／ｍｌ和８６．７０±２４．１８Ｕ／ｍｌ，与对照组相比Ｐ＜０．０５或Ｐ＜０．０１。各型患者血清中ＩＬ－１、ＩＬ－６和ＴＮＦα活性均有不同程度的增高。文中对ＳＨ患者ＩＬ－１、ＩＬ－６和ＴＮＦα之间的相互关系进行了探讨。     

干扰素对丙型肝炎病毒Ⅱ型和Ⅲ型的治疗反应

当前，α－干扰素（α－ＩＦＮ）是治疗丙型肝炎病毒（ＨＣＶ）感染的唯一有效药物，在影响α－ＩＦＮ治疗反应的诸多因素中ＨＣＶ基因型是最重要的因素。我们应用α－ＩＦＮ治疗ＨＣＶⅡ型和Ⅲ型感染者，从治疗后血清ＨＣＶＲＮＡ阴转为疗效判断指标，从而探讨α－ＩＦＮ...     

HCMV感染对单核细胞HLA－DR表达的影响

本文采用细胞ＥＬＩＳＡ法，研究发现人巨细胞病毒（ＨＣＭＶ）感染对单核细胞ＨＬＡ－ＤＲ的影响。结果表明ＨＣＭＶ感染后１ｄ，单核细胞ＨＬＡ－ＤＲ表达显著增高（Ｐ＜０．０１），以后逐渐降低，ｄ５降至对照水平；ＩＦＮγ（５００Ｕ／ｍｌ）．ＴＮＦ（２５０Ｕ／ｍｌ）、ＩＬ－６（５００／ｍｌ）、ＩＬ－１（５００／ｍｌ）均能不同程度地刺激单核细胞ＨＬＡ－ＤＲ表达；ＨＣＭＶ感染后，细胞因子刺激ＨＬＡ－ＤＲ表达的水平在感染后ｄ５，较对照组均显著降低（Ｐ＜０．０１）；ＩＬ－１＋ＩＦＮ－γ及ＴＮＦ＋ＩＦＮ－γ在刺激单核细胞ＨＬＡ－ＤＲ表达时有协同作用；ＨＣＭＶ感染后，ＩＦＮ－γ＋ＩＬ－１及ＴＮＦ＋ＩＦＮ协同刺激单核细胞ＨＬＡ－ＤＲ表达水平较对照组显著降低（Ｐ＜０．０１）。结果提示：在ＨＣＭＶ感染引起免疫抑制过程中，其引起单核细胞ＨＬＡ－ＤＲ表达降低是一重要机制。     

HCMV感染对单核细胞HLA－DR表达的影响

本文采用细胞ＥＬＩＳＡ法，研究发现人巨细胞病毒（ＨＣＭＶ）感染对单核细胞ＨＬＡ－ＤＲ的影响。结果表明ＨＣＭＶ感染后１ｄ，单核细胞ＨＬＡ－ＤＲ表达显著增高（Ｐ＜０．０１），以后逐渐降低，ｄ５降至对照水平；ＩＦＮγ（５００Ｕ／ｍｌ）．ＴＮＦ（２５０Ｕ／ｍｌ）、ＩＬ－６（５００／ｍｌ）、ＩＬ－１（５００／ｍｌ）均能不同程度地刺激单核细胞ＨＬＡ－ＤＲ表达；ＨＣＭＶ感染后，细胞因子刺激ＨＬＡ－ＤＲ表达的水平在感染后ｄ５，较对照组均显著降低（Ｐ＜０．０１）；ＩＬ－１＋ＩＦＮ－γ及ＴＮＦ＋ＩＦＮ－γ在刺激单核细胞ＨＬＡ－ＤＲ表达时有协同作用；ＨＣＭＶ感染后，ＩＦＮ－γ＋ＩＬ－１及ＴＮＦ＋ＩＦＮ协同刺激单核细胞ＨＬＡ－ＤＲ表达水平较对照组显著降低（Ｐ＜０．０１）。结果提示：在ＨＣＭＶ感染引起免疫抑制过程中，其引起单核细胞ＨＬＡ－ＤＲ表达降低是一重要机制。     

重组干扰素对慢性丙型肝炎抗病毒疗效5年随访观察

目的观察重组干扰素α－２ａ，α－２ｂ抗丙型肝炎病毒（ＨＣＶ）的近、远期疗效。方法重组干扰素α－２ａ治疗组７０例，重组干扰素α－２ｂ４６例对照组２８例，治疗后随访５年。结果治疗结束时，ＨＣＶＲＮＡ阴转率和血清ＡＬＴ复常率α－２ａ组分别为６７１４％和７０００％，α－２ｂ组分别为６９５６％和７１７３％，随访５年后，α－２ａ组ＨＣＶＲＮＡ阴转率和血清ＡＬＴ复常率分别为３５７１％和４７１４％，α－２ｂ组分别为３９１３％和５２１７％，均显著高于对照组（Ｐ＜００１和Ｐ＜００５）。基因分型以ＨＣＶⅠ组感染为主（７５８６％），干扰素对ＨＣＶⅡ组感染的疗效优于ＨＣＶⅠ组。结论重组干扰素α－２ａ与α－２ｂ均为有效的抗丙型肝炎病毒药物，慢性丙型肝炎患者干扰素治疗的早期疗效较好。ＨＣＶ基因型有预测干扰素疗效的意义     

抗氧化剂PDTC抑制氧化的低密度脂蛋白诱导的人肾小球系膜细胞NF_(-k)B活化

目的 研究氧化的低密度脂蛋白（Ｏｘ－ＬＤＬ）对体外培养的人肾小球系膜细胞（ＨＭＣ）核因子－ＫＢ（ＮＦ－ＫＢ）活化的影响，以及抗氧化剂毗咯二硫氨基甲酸酯（Ｐ ＤＴＣ）对ＮＦ－ＫＢ活化的抑制作用，探讨ＯＸ－ＬＤＬ介导肾损害的基因调控机制及抗氧化剂ＰＤＴＣ防治脂质肾损害的可能性。方法 将Ｏｘ－ＬＤＬ或ＰＤＴＣ与ＨＭＣ共培养后，提取细胞核蛋白进行凝胶迁移率变动分析（ＥＭＳＡ）检测ＮＦ－ＫＢ的活化，用细胞ＥＬＩＳＡ法检测细胞内ＩＫＢα蛋白含量的变化，反映ＩＫＢα的降解及免疫组化染色检测细胞内的Ｐ６５向核转位。结果 正常对照组未见ＮＦ－ＫＢ活化，当用不同浓度（１０、２５、５０及１００ｍｇ／Ｌ）的Ｏｘ－ＬＤＬ，刺激肾小球系膜细胞 ｌｈ后，均可引起细胞 ＮＦ－ＫＢ活化及 ＩＫＢα降解。与对只组相卜较差异显著（ｐ＜０．０５），以５０ｍｇ／Ｌ 的ＯＸ－ＬＤＬ刺激ＨＭＣ１ｈ，ＮＦ－ＫＢ活化及 ＩＫＢα降解最明显。ＮＦ－ＫＢ活化的同时，伴有Ｐ６５由胞浆向胞核的转位。１００μｍｏｌ／Ｌ ＰＤＴＣ，能明显抑制 ＮＦ－ＫＢ的活化、ＩＫＢα降解（ｐ＜０．０１）及 Ｐ６５的核转位。结论Ｏｘ－ＬＤＬ。能诱导ＨＭＣ的ＩＫＢαａ降解、Ｐ６５的核转位，最终使Ｎ     

细胞因子调节人肝癌细胞ICAM—1分子的表达及其对CD3AK杀伤功能…

应用基因重组人干扰素α（ＩＦＮ－α）、干扰素γ（ＩＦＮ－γ）和肿瘤坏死因子（ＴＮＦ）体外处理人肝癌细胞系Ｈ－７４０２，ＡＢＣ－ＣＥＬＩＳＡ法检测各处理组和对照组细胞间粘附分子－１（ＩＣＡＭ－１）的表达水平，用ＬＤＨ释放法观察ＣＤ３单克隆缺本活化的杀伤细胞对各处理条件下Ｈ－７４０２细胞的杀伤活性。     

病毒唑与干扰素联合治疗耐药丙型肝炎

病毒唑与干扰素联合治疗耐药丙型肝炎α干扰素（ＩＦＮα）治疗慢性丙型肝炎（ＣＨＣ）有７５％失败，病毒唑（Ｒｉｂ）亦仅暂时有效。Ｂｒｉｌｌａｎｔｉ等对Ｒｉｂ加ＩＦＮα联合治疗耐ＩＦＮαＣＨＣ的疗效进行了研究。２０例以前用过ＩＦＮα（３ＭＵ，每周３次共６月...     

羧甲基茯苓多糖对HPBL分泌IL—2,TNF,IL—6,IFN—γ的调节作用

用ＣＭＰ培养外周血淋巴细胞（ＨＰＢＬ）２４、３６、４８、７２ｈ采样检测的ＩＬ－２、ＴＮＦ、ＩＬ－６、ＩＦＮ－γ效价分别可达１３．６±４．３，４１．９±２．０，１８３７．４±４６４．３，１０３７．９±２１１．０Ｕ／ｍｌ，分别比无ＣＭＰ的细胞培养对照组的效价高０．８，７．４，０．５，１０．９倍（Ｐ＜０．０１），说明ＣＭＰ具有ＩＬ－２、ＴＮＦ、ＩＬ－６、ＩＦＮ－γ的诱生剂功能。由ＣＭＰ预处理ＨＰＢＬ后经ＰＨＡ和／或ＣｏｎＡ促诱生组的ＩＬ－２、ＴＮＦ、ＩＬ－６、ＩＦＮ－γ效价分别比无ＣＭＰ的ＰＨＡ和／或ＣｏｎＡ刺激的相应常规诱生组高１．２～２．８，０．５～１．１、０．５～０．８、０．４～０．６倍（Ｐ＜０．０１），尤以ＣＭＰ＋ＰＨＡ＋ＣｏｎＡ促诱生细胞因子效果最佳（Ｐ＜０．０１），说明ＣＭＰ又具有ＩＬ－２、ＴＮＦ、ＩＬ－６、ＩＦＮ－γ促诱生效应。     

Th17 / Treg 比率在慢性乙型肝炎患者外周血的动态变化及意义

目的: 通过比较不同治疗方法对慢性乙型肝炎(Chronic hepatitis B ,CHB) 患者外周血Th17(T helper lymphocyte 17)、Treg(regular T cell)细胞频率及Th17/ Treg 比率的变化,探讨其在CHB 患者疾病转归中的意义。方法:CHB 患者40 例,根据保肝治疗基础上是否加用核苷酸抗病毒药物分为未抗病毒治疗组(Chronic hepatitis B without antiviral,CHBWA)20 例、抗病毒治疗组(Chronic hepatitis B antiviral,CHBA)20 例、乙肝病毒携带者(Asymptomatic hepatitis B carriers ,AsC)10 例、健康对照组(Health control,HC)10 例;采用流式细胞术检测CHBWA 组0 月、1 月及CHBA 组0 月、1 月、3 月,AsC 患者和HC外周血Th17、Treg 细胞频率,计算Th17/ Treg 比率,观察其在疾病不同阶段的动态变化。结果:CHBWA 组保肝治疗1 月后,Th17/ Treg 比率(0.39±0.11)比0 月(1.20±0.26)明显降低(P<0.01),已接近AsC 组(0.39±0.14)及HC 组(0.42±0.20)Th17/Treg 比率水平(P>0.05),且Th17/ Treg 比率与ALT 有良好的正相关关系(r =0.709,P =0.000);在CHBA 组,Th17/ Treg 比率在1 月(0.73依0.32)、3 月(0.76±0.44)均较0 月(1.18±0.27)明显下降,与0 月比较差异有统计学意义(P<0.01),但继续治疗到3 月时Th17/ Treg 比率较1 月时变化不明显,Th17/ Treg 比率在0、1、3 月均高于AsC 组及HC 组(P<0.01,0.05);Th17/ Treg 比率与ALT、HBV DNA 有良好的正相关关系(r =0.500,P =0.000;r =0.345,P =0.007);两组间比较,0 月时两组间Th17/ Treg 比率差异无统计学意义(P>0.05),但经治疗1 月后CHBA 组Th17/ Treg 比率高于CHBWA (t=4.471,P<0.01)。结论:CHB 患者中,抗病毒治疗将迅速影响Th17、Treg 细胞频率,导致Th17/ Treg 比率的变化,其变化可能与清除病毒有关。     

Multicenter randomized study comparing initial daily induction with high dose lymphoblastoid interferon vs. standard interferon treatment for chronic hepatitis C

One hundred fifty-five chronic hepatitis C patients were assigned at random to receive natural lymphoblastoid interferon (IFN)alpha-n1, s.c., for 13 months in one of three treatment regimens: initial daily induction with 10 million units (MU) followed (group 1, n = 50) or not (group 2, n = 52) by 1 month of rest and then three times weekly 10 MU (2 months), 5 MU (2 months), and 3 MU (8 months); group 3 (n = 53) received tiw 5 MU (2 months) followed by 3 MU (11 months). By intention-to-treat analysis, ALT normalization at completion of treatment was greater in patients who received continuous IFNalpha-n1 therapy with initial daily induction (group 2: 24/52, 46%) compared with those given intermittent therapy with initial daily induction (group 1: 17/50, 34%) and those who received standard IFNalpha-n1 therapy (group 3, 18/53, 34%; P not significant). The sustained ALT response was 26%, 27% and 21% and the sustained virological response was 20%, 27%, and 19%, in groups 1, 2, and 3, respectively. A trend was observed towards a higher biochemical and virological end-of-treatment response in patients given induction therapy (17%) compared with standard therapy (6%, P = 0.053). Sustained biochemical and virological responses were 20%, 27%, and 17% in groups 1, 2, and 3, respectively. Platelet and leukocyte counts decreased following daily high-dose treatment and remained low until therapy cessation (P < 0.001). The data suggest that daily s.c. induction with 10 MU IFNalpha-n1 followed by intermittent or continuous maintenance therapy for 1 year does not improve the results achieved with the standard 1-year IFNalpha course in the treatment of chronic hepatitis C patients.     

比较α-干扰素不同联合治疗方案对儿童HBeAg阳性慢性乙型肝炎的疗效

目的评估两种不同的α-干扰素联合治疗对儿童HBeAg阳性慢性乙型肝炎的临床疗效。方法选择HBeAg阳性慢性乙型肝炎儿童120例,随机分为3组,每组各40例:第1组(A组)为α-干扰素(IFN-α)组;第2组(B组)为IFN-α 拉米夫定(LAM)组。第3组(C组)为α-干扰素(IFN-α) 乙肝疫苗组。其中干扰素疗程6个月,拉米夫定疗程6个月,所有病例均观察至12个月。结果治疗结束时丙氨酸转氨酶(ALT)复常率3组无差异。治疗6个月和12个月时B组HBeAg阴转率和HBV DNA的阴转率明显高于A组和B组,差异有统计学意义(P<0.05)。结论α-干扰素与拉米夫定联合治疗对HBeAg阳性慢性乙型肝炎儿童的病毒学应答(VR)疗效明显优于单用α-干扰素组和α-干扰素 乙肝疫苗组。     

Treatment with human gamma interferon of chronic hepatitis B: comparative study with alpha interferon

A pilot study was designed to determine the tolerance and effectiveness of natural or recombinant gamma interferon in patients with chronic hepatitis B. Sixteen patients received 0.5 to 3.0 million units (MU) per day of gamma interferon (IFN-gamma) for 7 days. Nineteen chronic hepatitis B patients who were treated with 5-6 MU leukocyte-derived alpha interferon (IFN-alpha) daily served as controls. All completed the treatment schedule. IFN-gamma exerted mild, but significant inhibitory effects (P less than .05) on serum DNA polymerase levels. However, the changes were significantly less (P less than .001) than those seen with IFN-alpha therapy when compared with percent change from basal values. In contrast, serum 2', 5'-oligoadenylate synthetase (2-5 AS) activities were markedly enhanced to a similar extent during therapy with both IFNs. Serum beta 2-microglobulin values were significantly increased by administration with both IFNs, although higher values were seen with IFN-gamma. Five patients received 1 MU IFN-gamma for 28 consecutive days and their HBeAg levels similarly decreased as those seen in patients treated with IFN-alpha. Side effects seemed to be greater during IFN-gamma therapy than IFN-alpha despite the lower doses used. The antiviral effect on serum HBV levels appeared less with IFN-gamma than with IFN-alpha. Alternatively immunomodulatory functions may have been enhanced with IFN-gamma in patients with chronic HBV infection.     

甲型H1N1流感患者排毒规律及抗病毒治疗研究

目的 研究2009年深圳市收治的甲型H1N1流感确诊病例排毒规律和抗病毒治疗疗效.方法 75例患者均经两次鼻咽拭子甲型H1N1流感病毒核酸检测阳性（RT-PCR）,此后每天检测病毒核酸直至连续两天均阴性.第1次病毒检测阳性后立即随机分三组抗病毒治疗,分别为奥司他韦（Oseltamivir）（组Ⅰ）、中药（组Ⅱ）和奥司他韦联合中药（组Ⅲ）抗病毒治疗,5 d为一疗程.应用流式细胞仪检测T细胞亚群和IL-17表达.结果 75例患者中,78.7%（59/75）在起病后甲型H1N1流感病毒核酸阳性持续≤7 d,平均年龄为（22.25±10.38）岁;21.3%（16/75）病毒持续＞7 d,年龄为（17.16±13.66）岁.对其中56例患者细胞与体液免疫功能进行分析,发现其IL-17表达明显低于季节性流感和健康人（P＜0.01）.进一步研究发现,10例病毒持续＞7 d的患者IL-17表达值（1.91±0.80）明显低于46例病毒持续≤7 d者IL-17表达（3.05±1.59）（P＜0.05）,也明显低于季节性流感（P＜0.01）和正常对照组（P＜0.001）.比较三治疗组抗病毒治疗5 d疗程结束时病毒核酸转阴率,分别为组Ⅲ92.86%,组Ⅰ71.43%,组Ⅱ46.15%,组Ⅱ明显低于前两组（分别为P＜0.01,P＜0.05）.组Ⅲ经治疗后体温恢复正常时间较组Ⅰ、组Ⅱ缩短（P＜0.05）.结论 IL-17和年龄与甲型H1N1流感病毒感染及排毒时间长短可能存在一定关系.奥司他韦联合中药治疗在抗病毒疗效和减轻症状方面均有其独特优势.     

Long-term follow-up of Japanese patients with chronic hepatitis B treated with interferon-alpha

The long-term usefulness of interferon-alpha (IFN-alpha) in chronic hepatitis B remains controversial. To investigate the long-term efficacy of IFN-alpha therapy in chronic hepatitis B, 62 Japanese patients, including 27 patients treated with IFN-alpha (IFN group) and 35 patients without antiviral therapy matched by age and sex as controls (control group), were followed up for 2-14 years. At entry, the serum alanine aminotransferase (ALT) level in the IFN group was significantly higher than that in the control group (238.6+/-250.1 vs. 142.3+/-152.1 IU/l, P < 0.05). The prevalence of genotype C was 89%, with no difference between the two groups (93 vs. 86%). There was no significant difference in the presence of the precore mutation or the dual core promoter mutations between the IFN and control groups (37 vs. 46%, 74 vs. 66%). After long-term follow-up, the rate of sustained HBeAg seroconversion was comparable in the two groups (33 vs. 31%). Normalization of serum ALT level was seen in 44% of the IFN group and 51% of the control group, with no difference. There was also no difference in the percentage of cases with loss of serum HBV-DNA by PCR assay between the two groups (33 vs. 29%). During follow-up, two patients of the control group and three patients of the IFN group developed cirrhosis, and one of the IFN- treated patients progressed to hepatocellular carcinoma. The results of this long-term follow-up study showed that no benefit of IFN-alpha treatment was detectable during long-term follow-up in Japanese patients with chronic hepatitis B.     

Comparison of tenofovir plus lamivudine versus tenofovir monotherapy in patients with lamivudine-resistant chronic hepatitis B

Background/Aims:

Tenofovir disoproxil fumarate (TDF) exhibits similar antiviral efficacy against treatment-naïve and lamivudine (LAM)-resistant chronic hepatitis B (CHB). However, there are few clinical reports on the antiviral effects of TDF–LAM combination therapy compared to TDF monotherapy in patients with LAM-resistant CHB.

Methods:

We investigated the antiviral efficacy of TDF monotherapy vs. TDF–LAM combination therapy in 103 patients with LAM-resistant CHB.

Results:

The study subjects were treated with TDF alone (n=40) or TDF–LAM combination therapy (n=63) for ≥6 months. The patients had previously been treated with TDF-based rescue therapy for a median of 30.0 months (range, 8–36 months). A virologic response (VR) was achieved in 99 patients (96.1%): 95.0% (38/40) of patients in the TDF monotherapy group and 96.8% (61/63) of patients in the TDF–LAM combination therapy group. The VR rates were not significantly different between the TDF monotherapy and TDF–LAM combination therapy groups (88.9 vs. 87.3% at month 12, and 94.4 vs. 93.7% at month 24, log-rank p=0.652). Univariate and multivariate analyses revealed that none of the pretreatment factors were significantly associated with VR.

Conclusions:

TDF monotherapy was as effective as TDF–LAM combination therapy for maintaining viral suppression in the vast majority of patients with LAM-resistant CHB, which suggests that TDF add-on therapy with LAM is unnecessary.     

Concomitant chemotherapy and IFN-alpha for small cell lung cancer: a randomized multicenter phase III study.

Patients with any stage of small cell lung cancer were given low-dose interferon-alpha (IFN-alpha) from the first day of treatment as long as possible irrespective of changes in treatment dictated by disease progression. All patients received 6 cycles of the chemotherapy (CT): cisplatin 70 mg/m2 i.v. day 1 and etoposide 100 mg/m2 i.v. days 1, 2, 3 every 28 days. Seventy-eight patients were assigned to arm 1: CT alone, 75 patients to arm 2: CT + natural IFN-alpha (3 MU three times a week i.m.), and 66 patients to arm 3: CT + recombinant IFN alpha-2a (3 MU three times a week i.m.). There was no difference in median survival between the arms (10.2 months, 10.0 months, 10.1 months, respectively), p = 0.32. The 2-year survival rates were 15%, 3%, and 11%, respectively. Grade 3 and 4 leukopenia occurred more frequently in the IFN arms than in the CT alone arm and resulted in dose reductions. Antibodies occasionally developed to recombinant IFN. We conclude that IFN-alpha can be administered concomitantly with chemotherapy but is probably better kept for maintenance therapy so that optimal full doses of induction CT can be given.     

抗病毒治疗对乙型肝炎病毒感染者肾移植术后临床转归的影响

目的 探讨乙型肝炎病毒感染者肾移植术后临床转归及治疗对策.方法 将术前乙肝病毒标志物阳性(HBsAg阳性、HBeAg阳性或HBeAb阳性、HBV DNA阳性或阴性)的32例肾移植术后患者分为抗病毒治疗组和无抗病毒治疗组两组.观察两组(术前1周至术后9年)的肝功能(ALT、AST、TBIL、PT)变化、病毒复制(HBV DNA)及存活情况.结果 抗病毒治疗组23例患者肝功能损害复常率为82.60%,存活率为82.60%,HBV DNA(PCR法)下降(≥2 log10)或保持低复制率为86.95%;未抗病毒组9例患者肝功能损害复常率为22.22%,存活率为11.11%,HBV DNA(PeR法)下降(≥2log10)或保持低复制率为11.11%.抗病毒组肝功能复常率、存活率及HBV DNA下降或保持低复制率高于无抗病毒组,两组比较差异有统计学意义(P<0.05).19例拉米夫定治疗患者6例出现病毒学反弹31.58%,1例加用阿德福韦酯,2例换用恩替卡韦后好转,其余3例肝功能衰竭死亡.结论 持续有效的抗病毒治疗可以有效控制乙肝病毒复制,促进肝功能恢复,减少肝衰竭发生,提高乙肝病毒感染者肾移植术后患者存活率.在治疗过程中出现病毒学反弹应及时换用或加用有效药物减少肝衰竭发生.     

抗病毒治疗对乙型肝炎病毒感染者肾移植术后临床转归的影响

目的 探讨乙型肝炎病毒感染者肾移植术后临床转归及治疗对策.方法 将术前乙肝病毒标志物阳性(HBsAg阳性、HBeAg阳性或HBeAb阳性、HBV DNA阳性或阴性)的32例肾移植术后患者分为抗病毒治疗组和无抗病毒治疗组两组.观察两组(术前1周至术后9年)的肝功能(ALT、AST、TBIL、PT)变化、病毒复制(HBV DNA)及存活情况.结果 抗病毒治疗组23例患者肝功能损害复常率为82.60%,存活率为82.60%,HBV DNA(PCR法)下降(≥2 log10)或保持低复制率为86.95%;未抗病毒组9例患者肝功能损害复常率为22.22%,存活率为11.11%,HBV DNA(PeR法)下降(≥2log10)或保持低复制率为11.11%.抗病毒组肝功能复常率、存活率及HBV DNA下降或保持低复制率高于无抗病毒组,两组比较差异有统计学意义(P<0.05).19例拉米夫定治疗患者6例出现病毒学反弹31.58%,1例加用阿德福韦酯,2例换用恩替卡韦后好转,其余3例肝功能衰竭死亡.结论 持续有效的抗病毒治疗可以有效控制乙肝病毒复制,促进肝功能恢复,减少肝衰竭发生,提高乙肝病毒感染者肾移植术后患者存活率.在治疗过程中出现病毒学反弹应及时换用或加用有效药物减少肝衰竭发生.