拉米夫定停药后肝炎26例的临床观察

目的探讨拉米夫定停药后乙型肝炎（拉米夫定停药后肝炎）的复发率、临床特征、发病机制及治疗。方法对长期服用拉米夫定治疗后停药的125例慢性乙型肝炎患者进行1年的随访。结果拉米夫定停药后肝炎的复发率为33．0％。其发病机制可能与HBV重新复制有关，与酪氨酸-蛋氨酸-天冬氨酸-天冬氨酸（YMDD）变异可能无关，乙型肝炎病毒e抗原（HBeAg）／抗HBe血清转换者也可发生拉米夫定停药后肝炎的复发。结论对长期服用拉米夫定的患者无论是否因发生血清转换而停药，均应密切观察肝功能、HBV-M及HBV-DNA，发生肝功能异常可用甘草酸二胺制剂等综合治疗和（或）再次应用拉米夫定治疗。

Clinical Observation of 26 Cases with Lamivudine Withdrawal Hepatitis B 26

Objective To Study the relapse rate, clinical characteristics, mechanism and treatment of lamivudine withdrawal hepatitis B. Method 125 patients with chronic hepatitis B treated with lamivudine were followedup for one year after its withdrawal. Resuh The total relapse rate of lamivudine withdrawal hepatitis B was 33.0%. Its probable cause was loss of inhibition of HBV which became reactivated, but having nothing to do with the variation of YMDD. Even those patients with serum conversion of HBeAg/anti - HBe also developed lamivudine withdrawal hepatitis. Conclusion In those patients receiving long - term treatment of lamivudine, even if they had serum conversion of HBeAg/anti - HBe and discontinued its administration, their liver function, HBV - M and HBV - DNA should alse be monitored during follow - up. In case of occurronne of lamivudine withdrawal hepatitis, glycyrrhizic acids can be given and/or lamivudine again.