干扰素α-2b联合拉米夫定治疗慢性乙型肝炎疗效观察

目的 观察干扰素联合拉米夫定治疗慢性乙型肝炎患者的疗效.方法 90例慢性乙型肝炎患者随机分为两组:42例干扰素α-2b联合拉米夫定治疗组,48例单用拉米夫定对照组:观察比较两组患者治疗后HBVDNA水平,乙型肝炎病毒血清标志物及肝功能变化.结果 治疗结束时,联合治疗组患者血清中HBVDNA阴性率和肝功能复常率明显高于单用拉米夫定治疗组,联合治疗组完全应答率40.5%,优于单用拉米夫定治疗组22.9%(P＜0.01);随访24周联合治疗组的上述指标仍高于拉米夫定对照组(P＜0.05).结论 干扰素α-2b联合拉米夫定治疗慢性乙型肝炎,可提高HBeAg/抗HBe血清转换率及综合应答率,并可防止或减少YMDD变异的发生.     

拉米夫定联合干扰素-α2b治疗慢性乙型肝炎68例

抗病毒治疗是慢性乙型肝炎治疗的关键，临床大量资料表明单一抗病毒治疗疗效不理想。联合用药已成为慢性乙型肝炎治疗的新出路。本院应用拉米夫定联合干扰素-α2b治疗慢性乙型肝炎68例。达到协同抗病毒作用。     

拉米夫定联合干扰素α-2b治疗慢性乙型肝炎疗效观察

目的比较拉米夫定联合干扰素α-2b与单用拉米夫定治疗慢性乙型肝炎的疗效。方法26例慢性乙型肝炎患者接受拉米夫定联合干扰素α-2b联合治疗1.5年;34例单用拉米夫定1.5年。结果治疗结束时,联合组HBeAg/抗HBe转换率为65.4%,优于单用组的37.6%(P<0.001);两组HBV DNA转阴率分别是96.2%、94.1%(P>0.05);联合组完全应答率38.5%,优于单用组17.6%(p<0.01)。单用拉米夫定组3例出现YMDD变异。联合治疗组出现1例HBsAg转阴。结论拉米夫定与干扰素α-2b联合治疗慢性乙型肝炎,可提高HBeAg/抗Hbe血清转换率及综合应答率,并可防止或减少YMDD变异的发生。     

拉米夫定联合α-干扰素治疗慢性乙型肝炎临床观察

目的 观察拉米夫定与α-干扰素治疗慢性乙型肝炎(CHB)的疗效。方法 对32例(CHB患者采用拉米夫定联合α-干扰素(α-IFN)抗病毒治疗。结果 接受联合抗病毒治疗的32例患者6个月内HBV DNA全部转阴,12个月内无反跳病例,与对照组比较有显著性差异(P<0.005);ALT复常率(87.5％),明显高于对照组患者(P<0.005)。结论拉米夫定联合α-IFN治疗CHB近期疗效较好,优于单一用药。     

单用拉米夫定与联合干扰素α-2b治疗慢性乙型肝炎临床对照观察

我们于2002年11月-2004年6月选择单用拉米夫定（LAM）与联合干扰素α-2b（IFNα-2b）治疗慢性乙型肝炎（CHB）各18例,现将对照观察结果报告如下。     

重组人干扰素α-2b联合拉米夫定治疗慢性乙型肝炎120例疗效观察

目的 研究重组人干扰素α-2b（安达芬）联合拉米夫定（LAM）对慢性乙型肝炎患者的疗效.方法 将120例慢性乙型肝炎患者按1∶1比例随机分为2组：联合组给予重组人干扰素α-2b和LAM治疗 单用组给予LAM治疗,疗程均为1年.结果 治疗1年后,联合组血清HBV-DNA转阴率和HBeAg/抗Hbe转换率均高于单用组（P均＜0.05）,单用组YMDD变异率高于联合组（P均＜0.05）.结论 重组人干扰素α-2b（安达芬）联合拉米夫定（LAM）治疗的1年疗效优于单用拉米夫定.     

拉米夫定与α-1b干扰素联合治疗慢性乙型肝炎

１．资料与方法：（１）病例选择：入选１３１例慢性乙型肝炎患者，男９７例，女３４例，平均年龄３５．２岁。入选条件：血清ＨＢｅＡｇ及ＨＢＶ ＤＮＡ阳性；血清总胆红素＜３０μｍｏｌ／Ｌ，ＡＬＴ为正常值上限的２～６倍；无合并症、并发症及重叠感染；入院前半年内未接受抗病毒药物及免疫凋节剂治疗。所有病例随机分为３组：Ⅰ组：α干扰素联合拉米夫定组４５例；Ⅱ组：拉米夫定组３６例；Ⅲ组：α干扰素组５０例。（２）治疗方法：Ⅰ组给予干扰素α—１ｂ２６周，同时给予拉米夫定５２周；Ⅱ组单独用拉米夫定５２周；Ⅲ组给予干扰素…     

拉米夫定分别与干扰素α-1b和胸腺肽联合治疗慢性乙肝疗效观察

我们自2002年1月-2003年12月间将拉米夫定分别与干扰素α-1b(IFN—α1b)和胸腺肽联合，用于治疗慢性乙肝取得了较好的疗效，现将有关资料报道如下：     

干扰素α-2b联合甘草酸二胺治疗慢性乙型肝炎临床观察

目的探讨干扰素α-2b联合甘草酸二胺治疗慢性乙型肝炎的临床疗效。方法两组病例分别应用干扰素α-2b及干扰素α-2b加甘草酸二胺治疗,观察治疗前后血生化指标及病毒学指标的变化。结果干扰素α-2b联合甘草酸二胺治疗组与单用干扰素α-2b组比较ALT复常率高(P<0.05);HBeAg及HBV DNA阴转率均无统计学差异(P>0.05)。结论干扰素α-2b联合甘草酸二胺治疗慢性乙型肝炎不能增强抗病毒作用,但对于肝损伤较重者,可考虑两者合用。     

拉米夫定联合干扰素α治疗慢性乙型肝炎疗效观察

目的研究拉米夫定联合干扰素α对慢性乙型肝炎病人的疗效。方法对1999~2001年深圳市东湖医院慢性乙型肝炎病人87例,随机分为2组,观察组36例,用拉米夫定(100mg/d)联合干扰素α(每次5mU)隔日1次肌注,26周后单用拉米夫啶至104周。对照组51例,单用拉米夫啶100mg/d,疗程104周,并评估疗效。结果两组HBVDNA转阴率差异无显著性(P=0.24),联合治疗组的HBeAg/抗-HBe血清转换率高于拉米夫定组(38.9%对17.6%,P=0.03)。联合治疗组的HBVYMDD变异率较低(22.2%对43.1%,P=0.04)。结论联合治疗的2年疗效优于单用拉米夫定,且能减少病毒YMDD变异。     

拉米夫定联合胸腺肽治疗慢性乙型肝炎的疗效观察

目的 评价拉米夫定联合胸腺肽治疗慢性乙型肝炎(CHB)的近、远期疗效和安全性，探讨两者联合治疗的协同作用。方法 将207例HBV DNA及HBeAg阳性的CHB患者随机分为甲乙两组，甲组采用拉米夫定和胸腺肽联合治疗，乙组单用拉米夫定治疗。胸腺肽15mg口服，每日1次，疗程6个月。两组拉米夫定治疗均为100mg，每日1次，口服，其中甲组92例(92／124)、乙组70例(70／83)用药超过12个月。两组在治疗6个月、12个月时分别进行疗效评价，治疗结束后继续随访12个月。结果 治疗6个月时，甲乙两组ALT复常率分别为87．1％和74．7％，甲组显著高于乙组(P＜0．05)，但两组HBV DNA阴转率、HBeAg阴转率及HBeAg／抗—HBe血清转换率均无显著性差异(P＞0．05)。治疗12个月时，甲乙两组ALT复常率和HBV DNA阴转率无显著性差异(P＞0．05)，甲组HBeAg阴转率及HBeAg／抗-HBe血清转换率均显著高于乙组(P＜0．05)。随访结束时，甲组从量复常率、HBV DNA阴转率、HBeAg阴转率及HBeAg／抗—HBe血清转换率均显著高于乙组(P＜0．05)。结论 拉米夫定与胸腺肽联合治疗CHB，疗效明显优于单用拉米夫定，是CHB患者安全有效的治疗方法。     

Extended treatment with lamivudine and adefovir dipivoxil in chronic hepatitis B patients with lamivudine resistance

Purpose

We and others have reported that adding adefovir dipivoxil (adefovir) to lamivudine results in virological and biochemical improvement in cases of lamivudine resistance. The current study assessed the efficacy and safety of combined therapy after 104 weeks of combined treatment and analyzed the frequency of persistent lamivudine resistant HBV.

Methods

A total of 78 patients with compensated CHB (Group A) were maintained on either adefovir 10 mg daily (n = 38) or placebo (n = 40) while continuing lamivudine. An additional 38 patients with decompensated cirrhosis or post liver transplantation (Group B) received lamivudine plus adefovir. The primary endpoint was HBV DNA response at year 2.

Results

At week 104 of therapy, a significantly greater proportion of patients in Group A on combination therapy (76%) had a decline in serum HBV DNA to ≤10⁵ copies or >2 log₁₀ reduction from baseline compared to those receiving lamivudine alone (13%; p < 0.001). Fifty-two percent of Group A patients on combination treatment continued to have the M204V/I HBV mutation compared to 92% receiving lamivudine alone (p = 0.0013). Virologic response occurred less frequently in patients expressing persistent lamivudine resistant HBV. In Group B, 87% of patients had HBV DNA response at week 104 (median change from baseline of −5.84 log₁₀ copies/mL).

Conclusions

The combination of lamivudine and adefovir for 2 years generally proved effective in lamivudine-resistant cases, but there was a persistently high rate of detection of lamivudine resistant mutants and impaired virologic response in compensated patients.     

α-2b干扰素联合苦参碱治疗慢性乙型病毒性肝炎临床疗效观察

目的　观察α 2b干扰素联合苦参碱治疗慢性乙型病毒性肝炎的临床疗效及对乙肝病毒标志物的影响。方法　选择深圳市东湖医院 1998- 0 8～ 2 0 0 4 - 0 2门诊及住院的慢性乙型肝炎患者 4 6 0例 ,随机分成治疗组2 95例 ,给予 10 %葡萄糖 2 5 0mL 苦参碱 15 0mg每日 1次静滴 (3个月 ) ,给予α 2b干扰素 5 0 0万单位 ,每日 1次肌肉注射 (10d) ,以后为隔日 1次 (6个月 )。对照组 16 5例 ,单用α 2b干扰素治疗 ,剂量疗程与治疗组相同。两组同时给予 10 %葡萄糖 15 0mL 强力宁 10 0mL每日 1次静脉滴注 3个月。同时观察两组患者的肝功能 ,乙肝病毒标志物的变化。结果　两组患者血清ALT及AST在治疗过程的复常率差异无显著性 (P >0 0 5 ) ,HbeAg阴转率分别是 5 7 0 %和 38 8% (P <0 0 1) ,HBVDNA阴转率是 5 9 3%和 4 2 4 % (P <0 0 1) ,抗Hbe阳转率是5 0 8%和 33 9% (P <0 0 1)。结论　α 2b干扰素联合苦参碱是治疗慢性乙型病毒性肝炎较有效的方法。     

拉米夫定与α干扰素联合治疗慢性乙型肝炎

目的 观察拉米夫定(LAM)联合干扰素α1b(IFNα1b)治疗慢性乙型肝炎的近期疗效和安全性。方法 HBV DNA和HBeAg均阳性的90例慢性乙型肝炎患者，按1：1：1的比例进入三个不同的治疗组。联合治疗组：用IFNα1b 5MU，隔日肌肉注射，及口服LAM 100mg／d，共6个月，随后单用口服LAM 100mg／d6个月；LAM组：口服LAM 100mg／d共12月：IFN组：IFN α1b 5MU，隔日肌肉注射，共6个月。结果 治疗结束时，HBV DNA转阴率，联合治疗组为90．0％，LAM组为80％，IFN组为46．7％。丙氨酸氨基转移酶(ALT)复常率，联合治疗组为90．0％，LAM组为80．0％，IFN组为53．3％。HBeAg／抗HBe血清转换率，联合治疗组为46．7％，LAM组为13．3％，IFN组为33．3％。联合治疗组患者治疗结束时无一例检测到YMDD变异。结论 联合治疗组对HBV DNA抑制作用及ALT复常率高于单用干扰素组，与单用拉米夫定组接近。HBeAg／抗HBe血清转换率高于拉米夫定组，与单用干扰素组相近。初步显示联合治疗组发生YMDD变异较少。     

Lamivudine and 24 weeks of lamivudine/interferon combination therapy for hepatitis B e antigen-positive chronic hepatitis B in interferon nonresponders

BACKGROUND/AIMS: Lamivudine is effective in treatment-naive patients with chronic hepatitis B, but its role in interferon nonresponders has not been described. We assessed lamivudine treatment, with or without added interferon, in patients with hepatitis B e antigen (HBeAg)-positive chronic hepatitis B who had failed interferon therapy previously. METHODS: Patients were randomized to lamivudine (100 mg) or placebo for 52 weeks or to a 24-week regimen of lamivudine plus interferon. Primary treatment comparisons were at week 52, with a 16-week posttreatment follow-up period. Measurements included histology (primary endpoint), HBeAg response, normalization of alanine aminotransferase, reduction of hepatitis B virus (HBV) DNA, and safety. RESULTS: Among 238 patients, histologic response was significantly more common in patients treated with lamivudine (52 versus placebo 25%, P=0.002) or the combination regimen (32%, P=0.01). HBeAg loss was also more common with lamivudine (33 versus 13 versus 21%), as were virologic and alanine aminotransferase responses. Among 28 subjects with HBeAg loss/seroconversion, 71% had durable responses 16 weeks posttreatment. CONCLUSIONS: Lamivudine for 52 weeks is as effective in interferon nonresponders as in previously reported treatment-naive patients; however, a combination of lamivudine for 24 weeks and interferon for 16 weeks was not effective in this population.     

Relationship between serum b2-microglobulin levels and virological breakthrough in HBeAg-negative chronic hepatitis B patients, under long-term treatment schedules including lamivudine

AIM: Predictive value of serum b2-microglobulin (b2m) levels for virological breakthrough (VB) in HBeAg-negative chronic hepatitis B (CHB) patients under long-term treatment schedules including lamivudine (LAM). METHODS: Serum b2m levels were calculated during treatment in 25 CHB patients under long-term LAM monotherapy (group A) and 12 patients under initial interferon plus LAM treatment followed by LAM monotherapy (group B), using the MEIA technology. We used Cox proportional hazard models in order to investigate the association between serum b2m levels and VB. RESULTS: Seven of 25 patients (28%), 9/25 (36%) and 14/25 (56%) from group A and 0/12, 2/12 (16.6%) and 3/12 (25%) from group B exhibited VB at months 12, 24 and 36 of treatment, respectively. All patients, from both groups, who did not show VB exhibited b2m elevation in mo 3. The duration of b2m elevation was significantly longer in the virological responder's subgroup from group A than the non-responder's one (7.3±2.6 vs 3.8±3.4 mo, P= 0.02). In comparison to group A patients whose b2m levels were increased at 3 mo, patients whose b2m levels were decreased had 4.6 times higher risk of experiencing VB (RR = 4.6, P= 0.024). When baseline variables were simultaneously included in the same Cox model, decreased b2m status was still associated with increased risk of VB (RR= 12.2, P= 0.03). CONCLUSION: In HBeAg-negative CHB patients under either long-term LAM monotherapy or initial combination treatment, serum b2m levels at 3 mo of treatment, compared to baseline ones, might be a predictor of risk for VB.     

拉米夫定治疗干扰素无应答的儿童慢性乙型肝炎疗效分析

目的 对干扰素治疗无应答的儿童慢性乙型肝炎使用拉米夫定序贯治疗,探讨拉米夫定对儿童慢性乙型肝炎的疗效和安全性.方法 40例干扰素治疗无应答的慢性乙型肝炎患儿,口服拉米夫定每日3 mg/kg体质量,最大量100 mg/d,观察3年;定期检查血清生化学指标、HBV血清标志物、HBV DNA定量变化;并测身高、体质量,记录不...     

单用拉米夫定与联合α干扰素治疗慢性乙型肝炎的疗效观察

目的观察和对比单用拉米夫定与拉米夫定联合α干扰素治疗慢性乙型肝炎的安全性和疗效.方法拉米夫定组64例,单服拉米夫定,100mg或150mg,每日1次,其中54例(84.4%)用药超过12个月.联合组49例,拉米夫定用药2周后加用干扰素(甘乐能或罗荛愫),3MU～5MU肌肉或皮下注射,每周3次,24周后停干扰素,继续服拉米夫定,其中38例(77.6%)治疗超过12个月.两组在治疗6个月、12个月时分别进行疗效评价,并继续随访4～26个月.结果拉米夫定组和联合组6个月时ALT/AST复常率分别为90.6%/92.2%和89.8%/93.9%(P＞0.05);HBVDNA阴转率分别为96.9%和98.0%(P＞0.05);HBeAg的血清转换率为20.3%和28.6%(P＞0.05).12个月时两组ALT/AST的复常率分别为90.7%/90.7和89.5%/92.1%(P＞0.05);HBV DNA阴转率为88.9%和89.5%(P＞0.05);HBeAg的血清转换率则分别为31.5%(17/54)和55.3%(21/38),P＜0.05.HBeAg的血清转换率似乎与治疗前的转氨酶水平较高、HBeAg和HBV DNA水平较低有关.治疗9～24个月期间拉米夫定组9例(14.1%)、联合组6例(12.2%)发生HBV多聚酶YMDD变异.结论拉米夫定和干扰素联合治疗慢性乙型肝炎,安全性和耐受性良好,1年后HBeAg的血清转换率显著高于单用拉米夫定组.     

聚乙二醇干扰素α-2a联合短程拉米夫定治疗HBeAg阳性慢性乙型肝炎的疗效

目的 探讨通过短程联合拉米夫定以提高聚乙二醇干扰素α-2a 疗效的新治疗方法.方法 所有患者以聚乙二醇干扰素α-2a 135μg开始治疗,在治疗12周时,若HBV DNA或HBeAg转阴,继续单独使用干扰素治疗至52周(A组),未达到上述条件者(B组)分为B1组及B2组,B1组短程联合拉米夫定治疗12周后继续干扰素治疗并完成52周疗程,B2组继续单独用干扰素治疗并完成52周疗程.符合正态分布的计量资料采用t检验;符合偏态分布的计量资料用中位数(全距)表示,采用秩和检验.结果共有58例患者入组,8例患者在治疗12周时出现HBV DNA或HBeAg转阴,单用干扰素完成52周疗程,治疗结束时HBV DNA转阴率、HBeAg血清学转换率,HBsAg转阴率及ALT复常率分别为8/8、6/8、0/8及8/8.B1组患者24例,治疗52周时HBV DNA转阴率、HBeAg血清学转换率,HBsAg转阴率及ALT复常率分别为50%(12/24)、38%(9/24)、4%(1/24)及63%(15/24);B2组患者26例,治疗52周时HBV DNA转阴率、HBeAg血清学转换率,HBsAg转阴率及ALT复常率分别为31%(8/26)、27%(7/26)、O(0/26)及35%(9/26).结论 聚乙二醇干扰素α-2a治疗取得早期应答的患者治疗52周的应答率高;通过对早期疗效不佳的患者短程联合拉米夫定治疗,可提高干扰素的疗效,但有待更大样本量的随机临床试验证实.