[CIHS访谈]乙型肝炎免疫治疗进展

东霸天

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一般来说人体内所有的DNA病毒都不能被根除。有些病毒会激活机体天然免疫，可能并不完全是致病的，所以我们并不都需要将其灭绝。


兄弟  这句话你怎么看？？？

smilingcloud

StephenW 发表于 2016-5-1 22:46
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Corticosteriod(as prednisone, 强的松) 用于降低炎症(inflammation), 乙肝患者 ...

核苷类抗病毒抑制HBV增殖疗法以前，被使用的免疫调节疗法Corticosteroid（CS法），
因其人为引起肝损伤的风险，现在已经被淘汰掉了。 老王的麻花疗法，绝非什么独创，只是新瓶装着旧酒。

http://www.ncbi.nlm.nih.gov/pubmed/10566734
Arase Y, Ikeda K, Murashima N, et al : Time course of histological changes in patients with a sustained biochemical and virological response to corticosteroid withdrawal therapy for chronic hepatitis B. Am J Gastroenterol 94 ; 3304―3309 :1999

Abstract
OBJECTIVE:
Although biochemical and virological responses to corticosteroid withdrawal therapy for chronic hepatitis B have been extensively studied, long term changes in liver histology have not been well documented.
METHODS:
We retrospectively analyzed 45 paired liver biopsy specimens taken before and after treatment from 40 patients who persistently showed biochemical remission and an absence of HBe antigen (RIA) for up to 20 yr.
RESULTS:
The grading scores for necroinflammatory and fibrotic activity in the liver specimens decreased significantly after corticosteroid withdrawal therapy. Histological scores graded according to Knodell's components improved significantly in every category after corticosteroid withdrawal therapy. However, inflammatory cell infiltrates remained within the liver for long periods. The disappearance rate of necroinflammation in the periportal, lobular, and portal regions of the liver were 25%, 7.4%, and 7.4%, respectively, at yr 5 after therapy, and were 84.4%, 78.2%, and 58.7%, respectively, at yr 10 after therapy. The cumulative disappearance rate, calculated using the Kaplan-Meier method, was significantly lower for portal inflammation than for periportal necroinflammation.
CONCLUSIONS:
Our results show that: 1) despite clinical remission of chronic hepatitis B virus infection, long periods are needed for histological resolution of necroinflammation in the liver; and 2) by a Cox proportional hazard analysis of the factors contributing to histopathological disappearance of disease-related inflammation, the degree of fibrosis of liver biopsy specimens from pretherapy patients was the most statistically significant factor (p = 0.049).

smilingcloud

StephenW 发表于 2016-5-1 22:46
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Corticosteriod(as prednisone, 强的松) 用于降低炎症(inflammation), 乙肝患者 ...

我对过去以及现在的免疫调节治疗方法的适用人群的个人理解如下图



“麻花”（免疫调节疗法）是用来吃着玩儿的，不是用来当药（抑制HBV增殖）的。

齐欢畅2

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可以根除的。但比较难，我们现在讨论的就是整合dna是否可以重新还原病毒。我们讨论的结论是很难，病毒即使整合了dna，但未必还能完整的表达病毒。或者我认为即使完全整合的dna要想复发，还是需要很苛刻的条件的。所以不需要过于担心。但是整合dna是可以表达一些蛋白质的。就像乙肝的整合dna，他的作用和cccdna类似，用于表达表抗。表抗是抑制人体免疫的重要抗原物质，所以病毒会不断的利用整合dna或cccdna制造表抗，从而逃避免疫监测，所以箭头公司的arc521思路应该是正确的。我看好他们。

东霸天

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谢谢你啊 兄弟  回答了我的问题  太感谢了

齐欢畅2

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举手之劳，何足挂齿。

东霸天

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那我也的谢谢兄弟  兄弟加我了 就是对我的照顾  再次感谢  我昨天给鑫可贤打电话了 问古巴药疗效的事  他们说  能让E抗原转阴  请问兄弟  这个对乙肝有帮助吗？E抗原转阴

齐欢畅2

银牌，其实也是不错的效果，关键是激活免疫，联手520就有戏了。