Эффективность различных схем противовирусной терапии у детей с хроническим гепатитом В

Abstract

Objective. To determine the effectiveness of various interferon therapy regimens in children with chronic hepatitis B (HBV). Patients and methods. The study included 126 children with HBV aged 3 to 17 years, who were treated in the pediatric infectious diseases department of the N.A.Semashko City Clinical Hospital in Samara. The diagnosis of HBV was confirmed by the detection of markers HBsAg, anti-cor IgM, HBeAg, anti-HBe. 88 (69.8%) patients with HBeAg(+) were registered, with HBeAg(‑) – 38 (30,2%). To exclude hepatitis D, total anti-HDVs were determined. Hepatitis B virus DNA was detected by polymerase chain reaction (sensitivity of the method is 10–15 IU/ml). The criterion for inclusion of patients with HBV in the study was the consent of parents and/or patients to antiviral therapy, the exclusion criterion was the presence of anti-HDV. The average age of the patients was 13.4 ± 2.5 years. To receive therapy, the children were divided into two groups. 62 patients of group I were prescribed monotherapy – recombinant interferon α-2b (IFN-α2b) for 24 weeks in a dose of 3 million IU 3 times a week. After 24 weeks patients who had the decrease in viral load (VL) >2 log continued treatment with IFN-a2b, and patients who did not have this were transferred to combination therapy – IFN-a2b 3 million IU 3 times a week every other day together with lamivudine (LV) 3 mg/kg 1 time per day every day.The II group, consisting of 64 patients, was immediately prescribed combination therapy – IFN-a2b + LV – 3 mg / kg 1 time per day daily for 48 weeks. with subsequent evaluation of the effectiveness of therapy. The duration of follow-up after the end of therapy was 12 months. Results. After antiviral therapy in both groups, regardless of the response to therapy, there was a significant decrease in the activity of alanine aminotransferase, aspartate aminotransferase compared with baseline data. In an individual analysis of high blood pressure in both groups before and after antiviral therapy, the number of patients with high blood pressure decreased by half and the proportion of patients with low blood pressure increased. In 15 patients (11.9%), the DNA of the hepatitis B virus stopped being detected. In most children (96.7%), interferon therapy was accompanied by the development of adverse events, most often flu-like (93.5%), asthenic syndromes (96.7%), which were stopped and did not interfere with further treatment. Key words: chronic hepatitis B, children, viral load, antiviral therapy