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目的:观察拉米夫定(lamivudine,LMV)对干扰素治疗无应答HBeAg阳性的慢性乙型肝炎患者的疗效。方法:73例干扰素治疗无应答患者停药后改用LMV100mg,q.d,口服(研究组),同期的82例为LMV初治患者(对照组),比较两组24月治疗期间和停药6月后血液生化学、HBV血清学及其分子生物学指标的变化。结果:研究组(73例、56例和42例)与对照组(82例、63例和45例)分别完成了LMV12,18,24月的治疗,研究组和对照组停药随访6月以上的患者分别为26例、19例。在24月的治疗后,两组ALT复常率和HBV-DNA阴转率未见显著性差异(P>0.05);研究组在LMV治疗6月与18月后,HBeAg的消失率与血清转换率均显著高于对照组(P<0.05);24月治疗后,研究组和对照组HBsAg的消失率分别为11.90%和2.22%,但未达到统计学差异(P>0.05);而研究组和对照组HBV-YMDD的累积变异率分别为16.44%和31.71%,均具有显著性差异(P<0.05);停药6月后研究组和对照组病毒学复发率分别为11.54%和21.05%,差异尚无统计学意义(P>0.05)。结论:LMV对干扰素治疗无应答的慢性乙肝疗效确切,其疗效显著优于LMV初治的患者。
Objective: To observe the efficacy of lamivudine (LMV) in HBeAg-positive chronic hepatitis B patients who did not respond to interferon treatment. Methods: 73 patients who did not respond to interferon treatment were switched to LMV100mg, qd orally (study group) after discontinuation of drug treatment and 82 patients who were treated with LMV during the same period (control group) Month after blood biochemistry, HBV serology and molecular biological indicators of change. Results: The study group (73 cases, 56 cases and 42 cases) and the control group (82 cases, 63 cases and 45 cases) completed the LMV12,18,24 month of treatment, the study group and the control group were discontinued for more than 6 months Of patients were 26 cases, 19 cases. After treatment in 24 months, no significant difference was found between ALT normalization rate and HBV-DNA negative conversion rate (P> 0.05). In the study group, the disappearance rate of HBeAg and serum conversion after LMV treatment in June and 18 months (P <0.05). After 24 months of treatment, the disappearance rates of HBsAg in study group and control group were 11.90% and 2.22%, respectively, but did not reach the statistical significance (P> 0.05) The cumulative mutation rates of HBV-YMDD and control group were 16.44% and 31.71%, respectively (all P <0.05). The virological recurrence rates in study group and control group were 11.54% and 21.05% , The difference was not statistically significant (P> 0.05). CONCLUSIONS: LMV is effective in treating chronic hepatitis B that does not respond to interferon treatment, and its efficacy is significantly better than that of patients who have been treated with LMV.