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Activation of cellular immunity, mainly cytotoxic T cells, plays an important role in the · mechanisms of cyclic acute exacerbation of hepatocellular damage (AE) in hepatitis B virus (HBV) carriers. Monitoring of the dynamics of immunoreactivity is clinically important to manage the patients and recognize the mechanism of liver damage. Serum neopterin has been widely- recognized as a marker of actiyation of cell-mediated immunity. We observed the clinical course of five hepatitis Be antigen I HBeAg ) positive HBV carriers with recurrent AE for mean eighteen months by monitoring of serum neopterin using a RIA kit. Alanine amino transferase (ALT) and HBeAg  were also measured serially as markers for hepatocne necrosis and viral replication, respectively During follow-up period. each patient had several episodes of AE alternating with normal or nearly normal liver function. The levels of serum neopterin changed dynamically related to those of HBeAg and ALT Temporal analysis of these makers before, during and after the episodes of AE showed a close involvement of the viral replication prior to the hepatocellular injury as well as the activation of cellular immunity following the viral replication. Immunological monitoring of serum neopterin could provide useful information about the dynamic interaction between virus replication, cellular immunoreactivity and hepatocellular damage. It was thought that serum neopterin can be used as a complementary marker to follow and manage chronic hepatitis B patients.

Serum Neopterin Monitoring in Hepatitis B e Antigen Positive Chronic Type B Hepatitis with Recurrent Acute Exacerbation