三联叠加疗法对慢性乙型肝炎患者乙型肝炎病毒复制和变异的影响

目的观察疗效确切的抗病毒药物和免疫调节剂,叠加伍用对慢性乙型肝炎病人HBV复制和变异的影响.方法应用拉米夫定、干扰素α-2b、黄芪注射液三联叠加疗法,对慢性乙型肝炎病人进行抗病毒治疗,并与单独应用拉米夫定的抗HBV效果进行比较评价.检测HBVDNA阴转率和HBeAg-抗HBe血清转换率;血清HBVDNA浓度;HBVDNA的YMDD变异率和前C区变异率.结果A组(叠加用药组)与B组(拉米夫定单药组)比较,HBVDNA阴转率分别在第12周、36周及48周差异有显著性(P<0.05),HBeAg阴转率在第36周、48周差异有显著性(P<0.05),抗HBe阳转率仅在第48周差异有显著性(P<0.05);两组患者血清HBVDNA浓度比较,治疗12周时降低程度差异有显著性(P<0.05),治疗第36周和48周时差异有非常显著性(P<0.01);治疗后12周,A组出现前C区BCP变异;疗后24周、36周和48周,两组均出现YMDD和前C区变异.结论与拉米夫定单独用药比较,三联叠加疗法可增加慢性乙型肝炎患者HBVDNA阴转率和HBeAg-抗HBe血清转换率,更显著降低血清HBVDNA浓度,并减少YMDD变异,故其抗HBV疗效优于拉米夫定单独用药.

Influence of a triplex superimposed treatment on HBV replication and mutation during treating chronic hepatitis B

OBJECTIVE: To observe and evaluate the influence of a new antiviral treatment scheme on HBV replication and mutation during treating chronic hepatitis B. METHODS: In the test group, lamivudine, IFN alpha-2b, Astragalus membranaceus were chosen as a triplex superimposed treatment scheme for treating the patients who were on the state of HBV high replication and involved in the clinical condition of chronic hepatitis B. The control group was treated with lamivudine alone. The observed parameters percentage of patients in whom HBV DNA became undetectable (serum HBV DNA<1.6 ng/L), HBeAg/anti-HBe seroconversion rate; HBV DNA serum level; HBV YMDD mutation rate and pre-C region mutation rate. RESULTS: Compared with that of the control group, HBV DNA undetectable rate of the test group increased markedly at weeks 12, 36, 48(P <0.05), HBeAg negative rate of the group increased markedly at week 36, 48(P <0.05), while anti-HBe positive rate increased only at week 48 (31.58 vs.19.23%, P <0.05). After 4 weeks of treatment, HBV DNA serum level of both the test group and the control group reduced very remarkably (P <0.01), and at week 48, reduced more significantly (P <0.001). Compared with the control group, HBV DNA serum level of the test group reduced notably at week 12 (P <0.05) and very notable at week 36 and 48(P <0.01). At week 12, the pre-C region mutation occurred in the test group, and at week 24, 36,48, the pre-C region and YMDD mutations occurred in both the test group and the control group. CONCLUSIONS: As to anti-viral treatment of chronic hepatitis B, the triplex superimposed treatment had better efficacy than lamivudine alone.