长疗程干扰素α-2b联合拉米夫定治疗慢性乙肝的临床观察

目的观察干扰素α-2b联合拉米夫定较长疗程治疗慢性乙型肝炎患者的疗效。方法将慢性乙型肝炎患者137例,随机分为两组,观察组61例,用干扰素α-2b（5万U/次,肌注）隔日1次,连用52周停药,52周后用拉米夫定100mg/d口服,1次/d,用至104周。对照组76例,单用拉米夫定,用法、用量、疗程同观察组。结果治疗104周后两组HBVDNA转阴率、ALT正常率差异无统计学意义（P=0.24）,观察组的HBeAg/抗-HBe血清转换率为42.6%,高于对照组的26.3%（P=0.045）,观察组的HBVYMDD变异率为14.5%,低于对照组的40.8%（P=0.001）。结论干扰素α-2b联合拉米夫定治疗慢性乙型肝炎,疗程2年,疗效优于单用拉米夫定,且能减少病毒YMDD变异。

Long-term effect of interferon alpha-2b combined with lamivudine in treatment for of chronic hepatitis B patients

Objective To study the effect of interferonα-2b and Lamivudine in chronic hepatitis B patients with a longer course of treatment.Methods 137 patients were enrolled and randomized into two groups.61 patients received interferonα-2b and lamivudine simultaneously for 52 weeks,then lamivudine alone for 52 weeks （combination group）.76 patients received lamivudine alone for 104 weeks （control group）.Results There was no difference between two groups in HBV DNA response and ALT normal rate （P=0.24）.Proportion of HBeAg/Anti-HBe serum conversion in combination group was significantly higher than control group （42.6% vs.26.3%,P=0.045）.HBV YMDD mutation rate in combination group was lower than in lamivudine group （14.5% vs.40.8%,P=0.001）.Conclusion The efficacy of combination therapy is better than lamivudine mono-therapy.Combination treatment may diminish the development of HBV YMDD mutation.