CAJ | 학술논문

目的用干扰素β-1a(IFN-β-1a)单独或联合利巴韦林(RBV)治疗慢性丙型肝炎患者,比较治疗前后的肝组织学的变化.方法慢性丙型肝炎患者21例,其中男14例、女7例,平均年龄(50±7)岁,随机分入IFN-β-1a单独治疗组(13例)和IFN-β-1a联合RBV治疗组(8例).共治疗24周,停药后观察24周.治疗前1年内行第1次肝组织活检,最后1次随访时(第48周)行第2次肝组织活检.对治疗前后的肝活检组织进行炎症坏死(HAI)积分、纤维化评分以及α-平滑肌肌动蛋白(α-SMA)、Ⅲ型胶原的免疫组化染色.结果 (1)21例患者7例获得了持续病毒学应答(SVR).(2)21例患者治疗前HAI(6.6±2.2)分,治疗后(4.3±2.2)分,治疗后HAI积分有明显改善(t=4.77,P＜0.01);SVR组与非SVR组患者的HAI改善程度的差异有统计学意义(t=2.04,P＜0.05).(3)治疗前纤维化评分为(1.7±1.2)分,治疗后(1.1±1.1)分,治疗后纤维化评分较治疗前有明显改善(t=1.92,P＜0.05).SVR中有71.40%的患者获得了肝纤维化改善,未获得SVR的患者中有42.96%获得了肝纤维化改善.(4)21例患者治疗前后α-SMA和Ⅲ型胶原的表达有差异(t值分别为2.15、1.83,均P＜0.05).(5)联合治疗的患者肝组织学评分更易获得改善.(6)肝组织纤维化评分与肝组织HAI积分、α-SMA评分和Ⅲ型胶原积分光密度值之间均呈正相关,相关系数分别为0.805、0.942、0.949,均P＜0.01).结论无论患者是否获得了病毒学应答,IFN-β-1a能有效改善慢性丙型肝炎患者的肝组织情况.α-SMA评分和Ⅲ型胶原积分光密度值能较好地反映肝纤维化程度.IFN-β-1a不仅能抗丙型肝炎病毒,还能直接抑制和扭转肝纤维化的进展.
목적 용간우소β-1a(IFN-β-1a)단독혹연합리파위림(RBV)치료만성병형간염환자,비교치료전후적간조직학적변화.방법 만성병형간염환자21례,기중남14례、녀7례,평균년령(50±7)세,수궤분입IFN-β-1a단독치료조(13례)화IFN-β-1a연합RBV치료조(8례).공치료24주,정약후관찰24주.치료전1년내행제1차간조직활검,최후1차수방시(제48주)행제2차간조직활검.대치료전후적간활검조직진행염증배사(HAI)적분、섬유화평분이급α-평활기기동단백(α-SMA)、Ⅲ형효원적면역조화염색.결과 (1)21례환자7례획득료지속병독학응답(SVR).(2)21례환자치료전HAI(6.6±2.2)분,치료후(4.3±2.2)분,치료후HAI적분유명현개선(t=4.77,P＜0.01);SVR조여비SVR조환자적HAI개선정도적차이유통계학의의(t=2.04,P＜0.05).(3)치료전섬유화평분위(1.7±1.2)분,치료후(1.1±1.1)분,치료후섬유화평분교치료전유명현개선(t=1.92,P＜0.05).SVR중유71.40%적환자획득료간섬유화개선,미획득SVR적환자중유42.96%획득료간섬유화개선.(4)21례환자치료전후α-SMA화Ⅲ형효원적표체유차이(t치분별위2.15、1.83,균P＜0.05).(5)연합치료적환자간조직학평분경역획득개선.(6)간조직섬유화평분여간조직HAI적분、α-SMA평분화Ⅲ형효원적분광밀도치지간균정정상관,상관계수분별위0.805、0.942、0.949,균P＜0.01).결론 무론환자시부획득료병독학응답,IFN-β-1a능유효개선만성병형간염환자적간조직정황.α-SMA평분화Ⅲ형효원적분광밀도치능교호지반영간섬유화정도.IFN-β-1a불부능항병형간염병독,환능직접억제화뉴전간섬유화적진전.
Objective To access the effect of pegylated interferon(PEGIFN)β-1a on the reduction of liver fibrosis in chronic hepatitis C(HVC).Methods Twenty-one patients with chronic HVC were divided into two groups randomly and treated with recombinant human PEGIHN-β-1a(n=13)or PEGIHN-β-1a plus ribavirin(RBV)(n=8)for 24 weeks,and then followed up for another 24 weeks.The clinical manifestations were observed and the clinical effects were evaluated.Biopsy was conducted before and after the treatment to analyze the histological activity index(HAI)and staging of fibrosis according the modified Knodell scoring system.Immunohistochemical analysis was used to examine the levels of α-smooth muscle actin(α-SMA),marker of activation of hepatic stellate cells(HSCs),and collagen type Ⅲ in the HSCs.Resalts Sustained viral response(SVR)was achieved in 7 patients,and end-of-treatment virologic response(ETVR)was achieved in 9 patients.The HAI after treatment was 4.3±2.2,significantly lower than that before treatment(6.6±2.2,t=4.77,P＜0.01).The fibrosis score after treatment was 1.1±1.1,significantly lower than that before treatment(1.7±1.2,t=1.92,P＜0.05).The α-SMA score after treatment was 14±8,significantly lower than that before treatment(20±11,t=2.15,P＜0.05).The integrated light density of collagen type Ⅲ after treratment was 10±10,significantly lower than that before treatment(16±12,t=1.83,P＜0.05).The improvement levels of fibrosis,α-SMA score,and integrated light density of collagen type Ⅲ of the patients with SVR were all better than those of the patients without SVR:however,the differences were all not significant.The patients with combination therapy,female patients,and the patients with the HCV RNA＜2×106 copies/ml before treatment all showed higher levels in histology response.HAI,α-SMA level,and collagen type Ⅲ values were all significantly correlated with the values of the semiquantitative indexes of fibrosis(all P＜0.01).Conclusion Resisting hepatitis virus C and inhibiting and reversing the fibrotic progress,IFN-β-1a therapy improves the liver histology of chronic HVC regardless of the viral response.