STUDIES OF THE NATURAL HISTORY AND TREATMENT OF CHRONIC HEPATITIS C

有充分证据的慢性丙型肝炎患者正在接受评估，以确定这种常见形式的慢性肝病的长期自然病史和评估治疗方法。以前的研究表明，阿尔法干扰素疗法对大约50%的患者有短期有益效果。在停用干扰素后，这种反应大约维持在10%-15%。利巴韦林的一项随机、安慰剂对照试验表明，这种核苷类似物1年的疗程与血清转氨酶活性和肝小叶坏死的显著改善有关，尽管血清中丙型肝炎病毒核糖核酸水平没有变化。持续2年的利巴韦林治疗证明了长期抑制治疗在本病中的实用性。干扰素和利巴韦林联合使用可获得更高的持续应答率。目前正在进行一项长期利巴韦林免疫疗法的对照试验；对标准的6个月干扰素和利巴韦林疗程无效并接受利巴韦林或安慰剂免疫疗法治疗并评估组织学改善的患者。60名患者参加了这项研究。丙型肝炎的自然病史是在一项研究中评估的，在这项研究中，患者被监测生化和病毒学测试，并在5年后再次接受肝脏活检。血清和肝组织的免疫学和病毒学评估侧重于阐明疾病的发病机制和恢复的决定因素。-抗病毒/干扰素/利巴韦林/联合治疗-人类受试者

Patients with well-documented chronic hepatitis C are being evaluated to determine the long-term natural history and evaluate therapies of this common form of chronic liver disease. Previous studies have shown that alpha interferon therapy has a short-term beneficial effect in approximately 50 per cent of patients. This response is sustained in approximately 10-15 per cent after stopping interferon. A randomized, placebo-controlled trial of ribavirin showed that a 1 year course of this nucleoside analogue is associated with significant improvement in serum aminotransferase activities and in hepatic lobular necrosis despite unchanged serum levels of HCV RNA. Continous ribavirin therapy for up to 2 years demonstrated the practicality of long term supressive therapy in this disease. A higher sustained response rate occurs with the combination of interferon and Ribavirin. A controlled trial of long term ribavirin immunotherapy is now underway; patients who do not respond to a standard 6-month course of interferon and ribavirin and treated with either ribavirin or placebo immunotherapy and assessed for histologic improvement. Sixty patients have enrolled in this study. The natural history of hepatitis C is evaluated in a study in which patients are monitored for biochemical and virologic tests and underwent repeat liver biopsies after 5 years. Immunological and virological assessment of the serum and liver tissue is focused on elucidating the pathogenesis of disease and the determinants of recovery. - Antiviral/Interferon/Ribavirin/Combination Therapy - Human Subjects