Efficacy of combination therapy of antiviral and immunosuppressive drugs for the treatment of severe acute exacerbation of chronic hepatitis B
Efficacy of combination therapy of antiviral and immunosuppressive drugs for the treatment of severe acute exacerbation of chronic hepatitis B
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DOI：
10.1007/s00535-008-2222-5
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发表时间：
2008-09-01
影响因子：
6.3
通讯作者：
Yokosuka, Osamu
中科院分区：
文献类型：
--
作者：
Fujiwara, Keiichi;Yasui, Shin;Yokosuka, Osamu
背景慢性B型肝炎严重恶化的患者，有时发展为暴发性肝衰竭，即使接受抗病毒治疗，死亡风险也很高。免疫抑制剂治疗慢性B型肝炎临床重度加重的疗效尚未得到充分证实。在这项研究中，我们评估了早期引入免疫抑制治疗联合抗病毒治疗对此类患者的疗效。方法.根据我们的统一标准，42例患者（29例男性和13例女性）被定义为慢性B型肝炎重度加重，并入选本研究。对1982年至1996年间的16例患者进行了回顾性分析。我们在1997年定义了严重疾病的标准，然后开始前瞻性地引入足够剂量的皮质类固醇。1999年后，核苷类似物与皮质类固醇联合给药。前瞻性分析了1997年至2007年间的26例患者。结果在1982年至1996年的回顾性研究中，16例患者中有4例（25%）康复。在1997年至2007年的前瞻性研究中，26例患者中有17例（65%）康复; 17例患者中有15例在诊断为严重疾病后10天内接受皮质类固醇联合或不联合抗病毒药物治疗，5例接受类似治疗但在诊断后10天内康复，3例接受抗病毒药物治疗的患者中有2例康复。结论.早期使用足够剂量的糖皮质激素和核苷类似物可能是逆转临床重度、危及生命的慢性B型肝炎急性加重患者病情恶化的一种选择。
Background. Patients with severe exacerbation of chronic hepatitis B, sometimes developing into fulminant liver failure, are at high risk for mortality even with antiviral therapy. The efficacy of immunosuppressive therapy in clinically severe exacerbation of chronic hepatitis B has not been well demonstrated. In this study, we evaluated the efficacy of the early introduction of immunosuppressive therapy in combination with antiviral therapy in such patients. Methods. Forty-two patients, 29 men and 13 women, were defined as having severe exacerbation of chronic hepatitis B based on our uniform criteria, and were enrolled in this study. Sixteen patients between 1982 and 1996 were analyzed retrospectively. We defined the criteria of severe disease in 1997, and then began to introduce sufficient doses of corticosteroids prospectively. Nucleoside analogs were administered in combination with corticosteroids after 1999. Twenty-six patients between 1997 and 2007 were analyzed prospectively. Results. In the retrospective study between 1982 and 1996, four of 16 (25%) patients recovered. In the prospective study between 1997 and 2007, 17 of 26 (65%) patients recovered; 15 of 17 patients treated with corticosteroids with or without antiviral drugs within 10 days after the diagnosis of severe disease recovered, none of five treated similarly but later than 10 days after the diagnosis recovered, and two of three treated with antiviral drugs recovered. Conclusions. The early introduction of sufficient doses of corticosteroids and nucleoside analogs could be one option for reversing the potential deterioration of patients with clinically severe, life-threatening exacerbation of chronic hepatitis B.