不同抗病毒药物治疗乙型肝炎的疗效及其对精子质量的影响

目的探讨干扰素、拉米夫定、阿德福韦酯治疗乙型肝炎患者的疗效及对患者精子质量的影响。方法选择我院2009年1月至2011年4月收治的慢性乙型肝炎患者共120例,入选患者根据不同的治疗方案分为三组,干扰素组、拉米夫定组和阿德福韦酯组,每组40例。比较三组患者治疗疗效及对精子质量的影响。结果三组患者均完成48周治疗,其中干扰素组、拉米夫定组、阿德福韦酯组患者HBeAg阴转率分别为10%、27.5%、37.5%,组间两两比较差异均有统计学意义(P<0.05)。HBV-DNA阴转率分别是32.5%、57.5%以及67.5%,组间两两比较差异均有统计学意义(P<0.05)。ALT复常率分别为40%、60%以及75%,组间两两比较差异均有统计学意义(P<0.05)。三组患者精子质量情况比较中显示,三组患者治疗12周、48周的精子密度、精子活力、精子活率显著低于治疗前,差异有统计学意义(P<0.05)。三组患者治疗48周的精子密度、精子活力、精子活率显著低于停药12周后,差异有统计学意义(P<0.05)。阿德福韦酯组的精子密度、精子活力、精子活率显著高于干扰素组、拉米夫定组,差异有统计学意义(P<0.05)。结论阿德福韦酯治疗乙型肝炎疗效显著,且对患者精子质量影响最小,乙型肝炎患者最佳生育时机为停药后12周。

Clinical efficacy of three main types of antiviral drugs in the treatment of hepatitis B and its influence on sperm quality

Objective To explore the effect of interferon, lamivudine and adefovir on the patients with chronic hepatitis B and the sperm quality. Methods One hundred and twenty patients （20～45 yeas old） with chronic hepatitis B in our hospital from January 2009 to April 2011 were divided into three groups according to different treatment： interferon group, lamivudine group and adefovir group, each with 40 patients. The effect of treatment and sperm quality in three groups were compared. Results After treatment for 48 weeks, the negative conversion rate of HBeAg and HBV-DNA were 10% and 27.5%, 37.5% and 32.5%, 57.5% and 67.5% in interferon group, lamivudine group, adefovir group, respectively, with statistically significant difference between the three groups （P0.05）. The normalization rate of ALT was 40%, 60%, 75% in the three groups, respectively, statistically significant difference between the three groups （P0.05）. In the three groups, the sperm density, sperm vitality, sperm motility rate 12 weeks and 48 weeks after treatment significantly lower than those before treatment （P0.05）, and the three parameters 48 weeks after treatment were significantly less than those 12 weeks after discontinuation of the medication （P0.05）. The sperm density, sperm vitality, sperm motility rate in Adefovir group were significantly higher than those in Interferon group and Lami-vudine group （P0.05）. Conclusion Adefovir has good therapeutic effect to treat hepatitis B and minimizes the effects of sperm quality. The best time to bear is 12 weeks after discontinuation of medicine.