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回复 王震宇 的帖子
非常简单，在暴发性肝炎, 用于在抗病毒药物生效之前, 抑制有损害的免疫反应.
Primary HBV infection can also cause fulminant hepatitis in patients with a marked immune responsiveness to the virus, while infection of immune-compromised hosts generally leads to the failure of virus immune control without evidence of acute hepatic damage.
The availability of nucleoside or nucleotide analogues (NUCs) as effective antiviral therapy has led to their application in patients with fulminant viral hepatitis B infection, and examples with apparently favourable effect have been reported[6,7]. Such observations and the lack of other clinical studies exploring additional therapeutic regimens has led to the recommendation in the 2012 EASL practise guideline to give antiviral therapy to patients with fulminant hepatitis B using NUCs with high resistance barrier such as tenofovir or entecavir, even if both drugs have not been studied systematically for this indication[8]. However, even these effective antiviral drugs generally need some weeks before HBV-DNA becomes undetectable and therefore they may be too slow to influence the clinical course of fulminant hepatic failure in hepatitis B. In view of the immunopathogenetic process involved in fulminant hepatitis B we reasoned that dampening the overwhelming antiviral immune response might actively contribute to the effectiveness of treatment, and report here our favourable experience in the first three patients managed by combining high-dose steroid therapy with standard anti-viral treatment.
原发性HBV感染还可以在对病毒具有显着免疫应答的患者中引起暴发性肝炎，而免疫受损宿主的感染通常导致病毒免疫控制失败而没有急性肝损伤的证据。
核苷或核苷酸类似物（NUCs）作为有效的抗病毒治疗的可用性已经导致它们在暴发性病毒性乙型肝炎感染患者中的应用，并且已经报道了具有明显有利作用的实例[6,7]。这些观察结果以及缺乏其他临床研究探索其他治疗方案已导致2012年EASL实践指南中建议使用具有高阻力的NUC（如替诺福韦或恩替卡韦）对暴发性乙型肝炎患者进行抗病毒治疗，即使这两种药物也是如此。没有系统地研究这种适应症[8]。然而，即使是这些有效的抗病毒药物通常需要几周时间才能检测到HBV-DNA，因此它们可能太慢而不能影响乙型肝炎暴发性肝功能衰竭的临床过程。鉴于暴发性乙型肝炎涉及的免疫病理过程我们推论抑制压倒性抗病毒免疫反应可能会积极促进治疗效果，并在此报告我们在前三名患者中通过将高剂量类固醇治疗与标准抗病毒治疗相结合的有利经验。
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4326162/ |
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楼主: alou
发表于 2018-11-20 12:40
