B형 바이러스성 만성 활동성 간염 환자에서 스테로이드 이탈요법 및 알파 인터페론 투여에 의한 면역상태의 변화

Abstract

Objectives: It has been suggested that cellular immune responses to the hepatitis B virus are of importance in the production of liver cell damage in chronic active hepatitis type B. Short-term corticosteroid withdrawal in patients with chronic active hepatitis type B is frequently associated with enhanced cellular immune responses to hepatitis B virus. Several clinical studies had suggested that short-term corticosteroid withdrawal followed by interferon treatment might enhance its antiviral efficacy. The present study was designed to investigate the change of immune parameters in patients with chronic active heptitis type B treatment with short-term corticosteroid withdrawal followed by interferon alpha(IFN-a). Methods: The subjects were 11 patients with chronic active hepatitis type B who were given prednisolone in decreasing daily doses of 60mg, 40mg and 20mg, each for 2 weeks, followed by a 4-week rest and l6 weeks of recombinant alpha 2a interferon (INF-α) was administered intramuscularly. Serum ALT level, serum HBV DNA level and serum sIL-2R level were assayed and CD4+ T cell/ CD8+T cell ratio, IL-2R+T cell/Total T cell(%), TLiSAI+T cell/Total T cell(%) and suppressor T cell activity were measured. Results: 1) The serum ALT level was increased significantly at 2 weeks after the end of prednisolone administration(p<0.005) and decreased significantly after the start of INF-α administration(p<0.005). 2) The serum HBV DNA level was increased significantly during the prednisolone administration(p<0.01) and decreased siginificantly after the end of prednisolone administration and resting period(p<0.05). 3) The serum sIL-2R level was increased significantly at 2 weeks after the end of prednisalone administration(p<0.05). After the end of prednisolone administration and the start of INF-α administration, the serum sIL-2R level was decreased significantly( p<0.05). 4) The increase of serum ALT level after the increase of IL-2R+T cell(%) and TLiSA1+ T cell/ Total T cell(%) after the increase of TLiSA1+T cell/ Total T cell(%) was significant. 5) The maximum increase of serum ALT level and the maximum decrease of suppressor T cell activity were observed in 4 of 5 patients(80.0%) at 2 weeks after the end of prednisolone administration. Conclusion: The serum HBV DNA level was decreased significantly by the immune rebound after the end of steroid administration. Probably increase of IL-2R+T cell/Total T cell(%) and TliSAl+T cell/ Total T cell(%) and decrease of suppresor T cell activity were related to the immune rebound.