医学论文-小儿慢性乙型肝炎干扰素治疗引起的抗纤维化效应.docVIP

医学论文-小儿慢性乙型肝炎干扰素治疗引起的抗纤维化效应 ???????????????????? ? 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（P0.05）。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（P0.01）。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 (P0.05) 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 (P0.01). 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