拉米脉冲对大三羊ALT正常的HBVer的益处(病毒性肝炎2004.11)

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Journal of Viral Hepatitis
Volume 11 Issue 6 Page 552  - November 2004
doi:10.1111/j.1365-2893.2004.00542.x


Beneficial effects of 'lamivudine pulse' therapy in HBeAg-positive patients
with normal ALT*

S. K. Sarin1, B. S. Sandhu1, B. C. Sharma1, M. Jain1, J. Singh1 and V.
Malhotra2
Summary. Currently no therapy is given to patients with chronic hepatitis B
virus (HBV) infection who are HBeAg positive with normal alanine
aminotransferase (ALT) levels. Steroid priming has been shown to enhance
T-helper-1 (Th-1) cell response. Lamivudine may restore immunologic
competence against HBV by causing a sudden decline in the level of the
virus. We examined the efficacy of lamivudine pulse therapy on the
seroconversion from HBeAg to anti-HBe. This was a prospective single-blinded
trial including 27 patients with chronic hepatitis B, HBeAg positive with
ALT 1.5 times upper limit of normal (ULN). Lamivudine was administered
initially for 4 weeks, then stopped for 2 weeks and later restarted and
continued till 3 months after seroconversion or completion of 2 years of
therapy. Twenty-six patients completed the study. Lamivudine withdrawal led
to a rise in ALT levels above the ULN in 11 (42.3%) patients at 6 weeks;
seven of them (63.6%) lost HBeAg compared with only two of the 15 patients
(13.3%), in whom ALT levels did not rise (P = 0.011). As one patient showed
a relapse, a total of eight (31%) patients responded to lamivudine pulse
therapy over a mean period of 17.3 ?4.5 months. Responders had a higher
serum albumin (P < 0.05), a lower fibrosis score (P < 0.05), and a
relatively high baseline serum ALT levels (P = 0.024) than the
nonresponders. YMDD mutations developed in three patients and none
responded. No patient developed hepatic decompensation. Hence lamivudine
pulse therapy has potential in converting HBeAg-positive, 'not-treat-worthy'
(ALT < 1.5 ULN) patients to treat-worthy (ALT > 1.5 ULN) in 42%, with
sustained HBeAg and HBV DNA loss in 31% patients. The effects are possibly
because of a combination of antiviral and immunomodulating activities of
lamivudine.

[此贴子已经被作者于2004-10-21 20:21:48编辑过]

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拉米脉冲对大三羊ALT正常的HBVer的益处(病毒性肝炎2004.11) Journal of Viral Hepatitis Volume 11 Issue 6 Page 552 - November 2004 doi:10.1111/j.1365-2893.2004.00542.x S. K. Sarin1, B. S. Sandhu1, B. C. Sharma1, M. Jain1, J. Singh1 and V. Malhotra2 摘要：目前针对HBeAg阳性，但是ALT正常的患者，没有任何治疗方案。类固醇填充物被证明可以提高T细胞反应。拉米可以通过快速降低病毒水平从而提高对HBV恢复免疫能力。我们检查了拉米脉冲式治疗（可以理解为间歇式治疗）方案对HBeAg到anti-HBe的血清转换的作用。这是一次有前景的单盲试验，包括27名慢性乙肝，HBeAg阳性，ALT为1.5倍的ULN。拉米

先复用4周，然后停2周，然而重新复用，指导血清转换3月或完成为期2年的治疗。26人完成试验。拉米的停药6周导致11名患者ALT水平上升超过ULN（42％）。7人失去了HBeAg，在ALT水平不高的15人中，仅有2人完成血清转换。其中一名病人复发，总共8人（33％）对拉米脉冲治疗有效，平均时间是17.3月。应答者ALT水平较高(P < 0.05), 纤维化分值小 (P < 0.05), 且有比未应答者有相对较高的ALT水平 (P = 0.024) 。3人中发生YMDD变异，且无应答者。没有病人发生失代偿. 应此，拉米脉冲式治疗有潜力将42%E抗原阳性的不值得治疗者(ALT < 1.5 ULN) 转为值得治疗者(ALT > 1.5 ULN) ，并且使其中31％的病人E抗原消失,HBVDNA消失。该效果主要来源是抗病毒和免疫调节相互作用的结果。

[此贴子已经被作者于2004-10-22 9:59:01编辑过]

天狼星

这种方法是有争议的。

逍遥散

这是实践着的“阴中求阳”论。请版主回顾一下我发过的帖子中的一段：

“对于分离免疫耐受所致的疾病中医早就确立了治疗原则。明代医家张景岳就提出：凡病有不可正治者，当从阳以引阴，从阴以引阳，各求其属而衰之。所谓从阴引阳，是指补充大队阴性免疫调节物质，满足体液免疫进程之需，然后少量阳性的免疫调节物质会使细胞免疫水平反弹上升，并可维持一段时期。我用浅白的语言可以形象地说明治病的机理：当一个人正瞌睡的时候，你只能为他送去枕头，当他一觉醒来，你再为他送去食物，他才会心甘情愿地替你干活儿。”