新疗法跟踪: 拉米+疫苗

Liver411

今年10月14-28在麻省波士顿召开的美国第54届肝脏病会议上专家提出. 拉米夫丁和乙肝疫苗合用治疗能够加快清楚HBV, 特别是病毒含量很高的病人. 我们都知道, 拉米夫丁对于HBV复制具有强劲的抑制能力. 而且重要的是它能够重组慢性乙肝患者的细胞免疫答应. 激发靶标病毒的T细胞是我们终止乙肝感染的有效途径. 据陈述, 乙肝疫苗在这方面有作用. 他们所作的试药表明, 这个论点是正确的. 拉米夫丁+乙肝疫苗联合治疗能够加快排除HBV, 并对突破性肝炎有控制作用. 进一步的用药方案和原理需要进一步研究. 不过它给治疗乙肝带来光明.

54th Annual Meeting of the American Association for the Study of Liver Diseases October 24 - 28, 2003, Boston, MA [B]Combination Therapy with Epivir-HBV (lamivudine) and HBV Vaccine May Accelerate Eradication of HBV, Especially in Patients with High Viral Loads[/B] Epivir-HBV (lamivudine/LAM) has a potent antiviral activity against HBV by directly inhibiting viral DNA synthesis, and has been shown to restore a cellular immune response in patients with chronic hepatitis B (CH-B). Boosting the virus-specific T cell response has been proposed as an means of terminating persistent HBV infection efficiently, and HB vaccine is reportedly effective for this purpose. The aim of this study was to assess the efficacy of combination therapy with Epivir-HBV (lamivudine) and HB vaccine in patients with chronic HBV infection. Fifty-five patients with CH-B, 35 with HBeAg+ and 20 with HBeAg-, were enrolled in the study, and randomized to receive either LAM monotherapy or the combination therapy of LAM and HB vaccine. Twenty-eight patients (18 with HBeAg+ and 10 with HBeAg-) received LAM 100 mg/d alone, and 27 patients (17 with HBeAg+ and 10 with HBeAg) received the combination therapy. In the combination therapy group, 100 mg/d of LAM was administered as a baseline treatment, and 10 μg of HB vaccine (HBsAg including preS2) was injected subcutaneously every month for 6 times starting at 2 months after the start of LAM administration. Serum HBV DNA levels (TMA method), HBV serologic status (HBsAg, HBsAb, HBeAg, HBeAb), and serum ALT levels were monitored before and at 2, 5, 8, 12 months after starting LAM. All patients were treated with LAM at least for 8 months. Study Results In the HBeAg- group, most of the patients responded well to the treatment, and their serum HBV DNA became negative within 2 months after starting LAM administration, except for one patient on monotherapy. None of them developed breakthrough hepatitis during the observation period (8 to 16 months). There were no differences between two groups with regard to serum levels of ALT and HBV markers during treatment. In the HBeAg+ group, undetectable levels of HBV DNA were observed in 29 % of the combination therapy group, and in 27% of the monotherapy group at 2 months after LAM administration. There was no difference between the two groups with regard to the ratio of HBV DNA negativity at this time point. However, it became significantly higher in the combination therapy group (81%) than in the monotherapy group (41%, p<0.05) at 5 months after LAM administration (3 months after vaccine administration). And the ratio of HBV DNA negativity tended to be higher in the combination therapy group throughout the observation period. Furthermore, breakthrough hepatitis was observed less frequently in the combination therapy group (27%) than in the monotherapy group (47%). The levels of serum HBeAg were decreased in both groups. However, they were not different between two groups at each time point. The serum HBsAg levels were unchanged during treatment in both groups. Conclusions The authors conclude, “The use of HB vaccine in combination with LAM may accelerate the eradication of HBV especially in the patients with high viral loads, and the combination therapy may be effective in controlling the occurrence of breakthrough hepatitis. The establishment of the protocol with higher efficacy in the combination therapy is required, and the detailed mechanism of action in the combination therapy should be analyzed.” 11/26/03 Reference T Ishikawa and others (Aichi Medical University School of Medicine, Aichi, Japan). COMBINATION THERAPY OF LAMIVUDINE AND HB VACCINE FOR THE TREATMENT OF CHRONIC HEPATITIS B. Abstract 1165 (poster). Hepatology 38:4 (Suppl). October 2003. (54th Annual Meeting of the American Association for the Study of Liver Diseases. October 24-28, 2003. Boston, MA.)

[此贴子已经被作者于2003-12-1 4:00:50编辑过]

凡人梦.

能介绍一下具体的治疗过程吗.???

匆匆过客

我正使用这个疗法。

如何进一步提高拉米夫定治疗慢性乙肝的临床疗效    （北京地坛医院（100011） 崔振宇 ）   

      众所周知，拉米夫定是一种有效的抗乙肝病毒药物。它对病毒的逆转录酶有明显的抑制作用，可抑制乙肝病毒的复制，但不能彻底清除复制模板ccc-DNA，故停药后可能复发。长期应用可诱发病毒变异及产生耐药现象。那么应如何提高其治疗慢性乙型肝炎的临床疗效呢？

    免疫功能异常是慢性乙肝持续不愈的主要原因之一，所以在用拉米夫定治疗的同时，再加用非特异性免疫增强剂（例如左旋咪唑搽剂）和特异性免疫增强剂（例如乙肝疫苗），有可能获得更满意的疗效。根据资料，左旋咪唑可以调节紊乱低下的免疫功能：其首先是增强T淋巴细胞的活性，增加巨噬细胞的吞噬功能和提高抗原递呈能力；同时还可增强机体的体液免疫功能，使抗体生成增多；此外，左旋咪唑还可诱生γ干扰素，增加白细胞介素-2受体表达。最近，张文君等在中华消化病杂志上发表的《拉米夫定联合左旋咪唑涂布剂治疗慢性乙型肝炎临床观察》 一文，联合用药满12个月后，治疗组HBV-DNA的转阴率为85％，抗HBe的阳转率为29.6％。均明显优于对照组。

    在联用拉米夫定与左旋咪唑同时，加用基因工程乙肝疫苗有可能进一步提高慢性乙肝低下的特异性免疫功能，从而可望进一步提高疗效。

touzi369

看来拉米加疫苗确是HBVER的一线曙光。

lhc200

等

廖谨全

这种疫苗要多少钱一针？

真实

我也很想了解具体情况

匆匆过客

8.5元/支。仅是一种探索疗法，心态应放平！

andy_liubin

为什么不说表面抗原转阴呢

匆匆过客

“表面抗原转阴”的话，正经人是不说的，明白人是不听的。