小儿慢性乙型肝炎干扰素治疗引起抗纤维化效应.docVIP

小儿慢性乙型肝炎干扰素治疗引起抗纤维化效应 　 作者：尹波 安萍 卞丽 曹艳雪 【摘要】 目的 观察儿童慢性乙型肝炎(CHB)应用 α干扰素(IFNα)治疗引起的抗纤维化效应。方法 30例小儿CHB应用IFNα治疗24周以上，且停药后随访36周，其中5例治疗前后均行肝活体组织检查。所有患儿均在治疗前、治疗后24周和36周，应用放射免疫法检测患儿血清肝纤维化标志物：透明质酸（HA）、层连蛋白（LN）、Ⅳ型胶原（ⅣC）。结果 应用IFNα治疗前(0周)、治疗后24周和36周,小儿CHB血清肝纤维化标志物HA值分别为（243.6±70.5）ng/mL、（145.2±51.6）ng/mL、（85.1±40.3）ng/mL；LN值分别为（180.5±61.3）ng/mL、（102.7±40.6）ng/mL、（62.8±32.6）ng/mL；ⅣC值分别为（137.1±48.6）ng/mL、（108.9±40.3）ng/mL、（70.5±30.7）ng/mL，治疗后血清肝纤维化标志物较治疗前显著下降（Plt;0.05）。肝活体组织病理检查显示，治疗后肝组织纤维化分期比治疗前有明显降低（Plt;0.01）。结论 IFNα在治疗小儿CHB时，不仅有抗病毒作用，在改善肝纤维化方面，也具有一定疗效。 【关键词】 儿童； 慢性乙型肝炎； 干扰素α； 肝纤维化 　　【Abstract】 Objective To investigate the clinical effect of IFNα for treatment of hepatic fibrosis in children with chronic hepatitis B. Method Thirty CHB children were given IFNα orally for twentyfour weeks. Before treatment and 24 and 36 weeks after the treatment，serum levels of hyaluronic acid (HA)，laminin (LN) and type Ⅳ collagen (ⅣC) of the patients were measured by radioimmunoassay and their liver biopsy specimens were also assessed. Results Before treatment and 24 and 36 weeks after the IFNα treatment ，serum levels of HA were（243.6±70.5）ng/mL ，（145.2±51.6）ng/mL and （85.1±40.3）ng/mL respectively;serum levels of LN were（180.5±61.3）ng/mL ，（102.7±40.6）ng/mL;（62.8±32.6）ng/mL respectively，ⅣC levels were（137.1±48.6）ng/mL，（108.9±40.3）ng/mL，and （70.5±30.7）ng/mL respectively. There was a significant reduction (Plt;0.05) in these serum values after the treatments. Histopathological examinations of the liver biopsies showed that the degree of hepatic fibrosis obviously declined by one or two degrees after the treatment (Plt;0.01). Conclusions IFNα not only has effect in antivirus treatment，but also has effect in treating hepatic fibrosis. 　　【Key word】 Children ;Chronic hepatitis B ;IFN ;Hepatic fibrosis. 　　小儿慢性乙肝病毒（HBV）感染大多因免疫耐受性而成为慢性无症状携带者，但发现不少就诊的儿童已打破免疫耐受，出现肝功损害、肝组织学的异常及血清肝纤维化指标的升高，成为慢性乙型肝炎（CHB）。小儿CHB的治疗原则与成人相同，给予α干扰素（IFNα）抗病毒治疗［1］。现将我院30例小儿CHB应用IFNα抗病毒治疗前后及跟踪随访观察肝纤维化指标的临床研