免疫疗法联合单磷酸阿糖腺苷治疗慢性乙肝观察研究

Observation of Immunotherapy Combined with ARA-AMP for Patients with Chronic Hepatitis B

目的 :探讨免疫疗法联合抗病毒药物对慢性乙型肝炎的治疗效果。方法 :重组乙肝疫苗 30 μg ,肌注 ,每月一次 ,共 (6～ 8)个月 ;同步使用胸腺肽 5 0mg ,肌注 ,隔日一次 ,共 3个月 ;单磷酸阿糖腺苷 (1～ 6 )天 ,0 .4 /日静点 ,第 (7～ 2 8)天改为 0 .2 /日 ,静点 ,之后再重复一疗程。对照组单用单磷酸阿糖腺苷 ,剂量、方法、疗程同上 ,并使用一般性保肝药物肝泰乐、甘利欣等。结果 :ALT复常率两组差别无显著性 ,而HBeAg阴转率治疗组 4 4.7% ,对照组 14 .3% ;HBV -DNA滴度下降率治疗组 5 9.6 % ,阴转率 19.1% ,对照组分别为 2 3.8%、4 .7%。两组差别有显著性 (P <0 .0 5 )。结论 :使用较大剂量乙肝疫苗作为特异性免剂制剂 ,联合非特异性制剂胸腺肽打破机体免疫耐受 ,在此基础上使用抗病毒制剂单磷酸阿糖腺苷 ,抑制HBV -DNA ,使HBeAg阴转及HBV -DNA滴度下降乃至阴转均有较好的疗效。

Objective: To observe the therapeutic effect of immunotherapy combining with anti-virus medicine for patients with chronic hepatitis B. Methods: All cases were divided into the test group and the control group. In the test group, the recombined hepatitis B vaccine was given (30μg i.m, once/month for 6～8 months) + thymopeptide (50mg im, once/2d for three months)+ARA-AMP (0.4/d iv drip for 1-6day, then repeat one course of treatment). The control group only used same ARA-AMP as above and the common liver-protective medicine such as Glucurolactone and Diammonium Glycyrrhizinate etc. Results: There is no significant difference in the recovery rates of ALT between two groups, but the rate of negative transition is 44.7% and14.3% in the test and control group separately. 59.6% the descending rate of HBV--DNA titer and 19.1% the rate of negative transition was found in the test group; 23.8% and 4.7% respectively in the control group, and there is a significant difference (P<0.05).Conclusions: It is a better way that on the basis of that larger dosage hepatitis B vaccine as specific immunized preparation +non-specific immunized preparation thymopeptide can brake down the immune tolerance of patients with hepatitis B, using the anti-virus preparation ARA-AMP can suppress HBV-DNA up to negative HBeAg and the decreased titer of HBV-DNA.