The change of serum tumor necrosis factor-α level and its clinical significance during the treatment of chronic hepatitis B with lamivudine

Objective: To evaluate the effect of lamivudine on immunity of chronic hepatitis B by observing the sequential changes of serum TNF-α and HBV-DNA level. Methods: 31 CHB patients with elevated serum ALT/AST level and HBVDNA level higher than 10⁶ copies/mL were treated with lamivudine (100mg/day) for one year. The sequential serum samples, which were taken at the 0, 3^rd, 6^th, 12^th month after initiation of therapy, were used to detect serum level of TNF-α and quantity of HBV-DNA respectively. Results: 1 The serum TNF-α levels were higher than normal value before treatment in all patients; 2 At In the 3^rd month of treatment, The the serum HBV-DNA level began to decline and became negative in the 54.9% of all patients. At the end of treatment, HBV-DNA was negative in 48.4% of all patients; 3 The decrease of TNF-α level was later than HBVDNA level drop. TNF-α level began to decline after 6 months treatment. At the end of treatment, TNF-α level was lower than that at in 6^th month, TNF-α level returned to normal in the 38.7% of all patients; 4 The TNF-α level decreased significantly after 6 months treatment in the patients with ALT>80 IU/L at the beginning of treatment. But in the patients with ALT<80 IU/L, the TNF-α level decreased just after 12 months treatment; 5 TNF-α level fell obviously and early in patients whose HBVDNA became negative at in the 3^rd month. Conclusion: Lamivudine can suppress the replication of HBVDNA quickly, and decrease TNF-α level in the serum TNF-α level. It suggests that lamivudine can modulate immune response directly or indirectly. The changes of serum TNF-α level may be used to evaluate the clinical efficacy of lamivudine.