肝炎灵联合苦参碱注射液治疗慢性乙型肝炎98例

目的:探讨苦参碱联合肝炎灵注射液在慢性乙型肝炎抗病毒治疗方面的疗效。方法:将98例慢性乙型肝炎患者分为治疗组52例和对照组46例,治疗组应用苦参碱注射液150mg加入10％葡萄糖溶液中静脉滴注,同时应用肝炎灵注射液70mg,肌注,1次/d,疗程14周。治疗前后各检测1次肝功能,HBeAg、HBsAg及HBV DNA。结果:治疗组患者HBeAg、HBV DNA阴转率分别为40.4％(21/52)、42.3％(22/52);对照组分别为13.0％(6/46)和15.2％(7/46),差异有非常显著性意义(P<0.01);治疗组ALT、AST复常率也显著高于对照组(P<0.05)。结论:肝炎灵联合苦参碱注射液能有效抑制乙肝病毒(HBV)的复制,是治疗慢性乙型肝炎安全有效的药物。     

氧化苦参碱注射液治疗慢性乙型肝炎43例分析

慢性乙型肝炎(HBsAg~+、HBeAg~+、HBV DNA+)86例,随机分成2组,治疗组43例,使用博尔泰力(氧化苦参碱)注射液40mg/d,肌注,3个月。对照组43例使用肝炎灵4ml/d,肌注,3个月。治疗结果(3个月后):2组ALT复常率分别为95.3％和97.1％,HBeAg转阴率分别为41.2％与3.9％,HBV DNA转阴率分别为39.5％与9.3％,2组间肝功能复常率相比无显著差异P>0.05,而HBeAg及HBV-DNA转阴率相比均有显著差异P<0.05,提示氧化苦参碱注射液治疗慢性乙型肝炎疗效较好。     

氧化苦参碱联合肝炎灵注射液治疗慢性乙型肝炎60例分析

目的 探讨氧化苦参碱注射液联合肝炎灵注射液治疗慢性乙型肝炎的疗效。方法 60例患者应用氧化苦参碱150mg加入10％葡萄糖液中静脉滴注，同时给予肝炎灵70rag肌肉注射，每日一次，疗程12周。另30例患者接受拉米夫定和甘利欣治疗。结果 治疗结束时第一组HBeAg和HBVDNA阴转率分别为40．7％（21／60）和43．3％（26／60）、ALT、AST的复常率均为100％，优于第二组。结论 氧化苦参碱联合肝炎灵注射液能有效抑制HBV复制，治疗慢性乙型肝炎安全有效。     

苦参碱联合甘利欣注射液对慢性乙肝肝纤维化的影响

[目的]观察苦参碱联合甘利欣注射液对慢性乙型肝炎(乙肝)肝纤维化的影响。[方法]将136例慢性乙肝患者随机分为2组,治疗组72例采用苦参碱联合甘利欣注射液治疗,对照组64例采用拉米夫定治疗,6个月后观察2组患者肝功能、乙肝病毒(HBV)标志物以及肝纤维化4项指标的变化。[结果]与治疗前相比,2组均能显著降低血清丙氨酸氨基转移酶(ALT)、天冬氨酸转氨酶(AST)、透明质酸(HA)、Ⅲ型前胶原肽(PCⅢ)、层黏连蛋白(LN)、Ⅳ型胶原(Ⅳ-C),提高清蛋白/球蛋白比值(A/G)(均P0.01);在降低ALT、AST、HA、PCⅢ、Ⅳ-C方面,治疗组明显优于对照组(P0.05);对照组HBV DNA阴转率高于治疗组(P0.05),治疗组HBeAg阴转率优于对照组(P0.01)。[结论]苦参碱联合甘利欣注射液可抑制慢性乙肝肝纤维化,同时还可抑制HBV复制,促进HBV复制标志物阴转,降低转氨酶,改善肝功能。     

苦参碱联合甘利欣治疗慢性乙型肝炎40例疗效观察

观察苦参碱联合甘利欣治疗慢性乙型肝炎的疗效。 80例住院患者随机分为对照组和治疗组 ,每组各 4 0例。对照组给甘利欣及常用护肝药物。治疗组在对照组基础上联用苦参碱 15 0mg/日 ,加入葡萄糖液中滴注 ,疗程两组均为 10 - 2 0天。结果对照组与治疗组治疗 10天及 2 0天后 ,临床总有效率分别为 6 2 5 %、72 5 %及 70 0 %、85 0 %两组间无显著差异 ;但肝功能TBil在治疗 10天时两组分别为 (6 6 0 6± 88 5 0 )及 (31 5 8± 33 5 1) (t=2 2 0 ,P <0 0 5 ) ;乙肝病毒HBsAg及 /或HbeAg转阴两组分别为 2 5 %、15 0 % ,二者有显著差异。苦参碱联合甘利欣确能改善肝功 ,抑制HBV复制 ,是治疗慢性乙肝的有效联合。     

免疫疗法联合拉米夫定治疗慢性乙型肝炎应用研究

目的 探讨免疫疗法联合拉米夫定对慢性乙型肝炎(CHB)的抗病毒治疗效果。方法 治疗组(免疫疗法 拉米夫定)76例，对照组(单用拉米夫定)38例。2组病例根据血清ALT、HBV标志物水平分为免疫耐受期、免疫清除期。免疫疗法包括应用乙型肝炎疫苗、绿脓杆菌菌毛注射液、胸腺肽注射液。结果 免疫清除期病例的HBeAg阴转率治疗组为15／34(44．1％)，对照组为2／17(11．8％)，P＜0．05。HBV DNA阴转率2组分别为82．5％和70．6％。免疫耐受期病例的HBeAg阴转率治疗组为11／42(26．2％)，对照组1／21(4．8％)，P＜0．05。HBV DNA阴转率治疗组为23／42(54．8％)，对照组6／21(28．6％)，P＜0．05。结论 免疫疗法联合拉米夫定可以提高CHB患者HBeAg及HBV DNA阴转率。     

拉米夫定加肝络欣治疗慢性乙型肝炎疗效及对YMDD变异的影响

观察拉米夫定加肝络欣联合治疗慢性乙型肝炎的疗效及对慢性乙型肝炎病毒P基因(YMDD)变异的影响。收集乙型肝炎病毒(HBV)HBeAg、HBVDNA阳性的慢性乙型肝炎患者6 7例,分为拉米夫定加用肝络欣组(A组)、单用拉米夫定组(B组)。分别检测血清HBeAg、抗-HBe、HBVDNA ,肝脏生化指标和基因YMDD变异。在治疗5 6周时,拉米夫定联合肝络欣组HBeAg/抗-HBe转换率(39. 4 % ) ,优于拉米夫定组(P <0 .0 5 )。HBVDNA阳性率及YMDD变异率都比拉米夫定组低(P <0 . 0 5 )。拉米夫定联合肝络欣能在一定程度上提高治疗慢性乙型肝炎的疗效并可减少YMDD变异。     

拉米夫定联合苦参碱治疗慢性乙型肝炎疗效观察

目的　探讨拉米夫定联合苦参碱治疗慢性乙型肝炎(CHB)的临床效果。方法　将63例慢性乙型肝炎随机分成两组:A组接受拉米夫定联合苦参碱治疗;B级单纯接受拉米夫定治疗。结果　A、B两组患者血清HBVDNA阴转率分别为94.1%和89.7% ,差异无显著性;A组HBeAg阴转率显著高于B组(5 0 .0 %对17.2 % ,P <0 .0 1)。结论　拉米夫定联合苦参碱治疗慢性乙型肝炎可提高患者血清HBeAg阴转率和ALT复常率。     

苦参碱治疗慢性乙型肝炎的疗效观察

目的　观察苦参碱、干扰素及其联合应用治疗慢性乙型肝炎的临床疗效及其副作用。方法　选用同期住院的慢性乙型肝炎 93例 ,随机分为苦参碱治疗组 2 0例、干扰素治疗组 2 3例、联合治疗组 2 5例、对照组 2 5例。治疗前后检测HBVM、HBVDNA。结果　HBeAg阴转率、HBeAb阳转率及HBVDNA阴转率联合治疗组分别为 60 %、5 2 %、64 % ,明显高于苦参碱治疗组 3 5 %、3 0 %、40 % (P <0 .0 1) ;也明显高于干扰素治疗组 43 .48%、3 4.78%、3 9.13 % (P <0 .0 1) ;苦参碱组与干扰素组两组相比差异无显著性 (P >0 .0 5 ) ;三个治疗组与对照组相比有显著差异 (P <0 .0 1)。结论　苦参碱有明显抗乙型肝炎病毒作用 ,临床疗效与干扰素相似 ,二者联合应用可显著提高疗效 ,且副作用轻。     

拉米夫定与乙肝特异性主动免疫联合疗法治疗慢性乙型肝炎病毒携带者的前瞻性临床研究

目的　对拉米夫定与乙肝特异性主动免疫联合疗法治疗慢性乙型肝炎病毒携带者的临床效果。方法 10 0例慢性乙型肝炎病毒携带者 ,随机分为联合治疗组 ( 5 0例 )用拉米夫定 10 0mg/日 ,加用乙肝特异性主动免疫联合疗法每 4周 1次 ,疗程为 48周 ;对照组为拉米夫定单一治疗 ( 5 0例 ) ,用拉米夫定 10 0mg/日 ,口服。结果　联合治疗组HBsAg阴转率 ( 18%) ,抗 HBs阳转率为 6%,而拉米夫定单一治疗组分别为 4%和 0 %,P <0 .0 0 1;联合治疗组HBeAg阴转率 40 %以及HBeAg血清学转换 (HBeAg消失、抗 HBe阳转 )率为 3 0 %,均高于拉米夫定单一治疗组 ,P <0 .0 5。结论　拉米夫定与乙肝特异性主动免疫联合疗法的疗效优于单一口服拉米夫定疗法     

肝毒清治疗慢性乙型肝炎的临床研究

目的：探讨纯中药浓缩胶囊肝毒清对慢性乙型肝炎的临床疗效。方法：４８例慢性乙型肝炎患者每次口服肝毒清胶囊８粒,每日３次;３０例对照组患者每次口服灭溴灵片６片,每日３次。两组均于治疗前和治疗后的０、３、６个月检查ＡＬＴ、ＡＳＴ、Ａ／Ｇ、ＴＢｉｌ、ＨＢＶ５项指标及ＨＢＶ－ＤＮＡ（ＰＣＲ法）进行对比。结果：肝毒清组总有效率８９．５％,对照组为６６．６％;ＨＢｅＡｇ、ＨＢＶ－ＤＮＡ阴转率,肝毒清组为４８．５     

拉米夫定联合博尔泰力治疗慢性乙型肝炎临床研究

为探讨拉米夫定与博尔泰力联用对慢性乙型肝炎的临床治疗价值，将60例慢性乙肝患者随机分为两组，一组接受拉米夫定和博尔泰力联合治疗（LM组）。另一组单纯接受拉米夫定治疗（L组），结果两组HBVDNA阴转率分别为93．75％和89．29％，差异无显著性意义。但LM组HBeAg阴转率和ALT复常率均显著高于L组（50％对17．85％，P＜0．01和81．25％对50％，P＜0．05），两组不良反应发生率相近。拉米夫定联合博尔泰力治疗慢性乙型肝炎可有效地提高HBeAg阴转率和ALT复常率，且有希望缩短拉米夫定在慢性乙型肝炎治疗中的疗程。     

Serum markers of hepatitis B virus replication, liver histology and intrahepatic expression of hepatitis B core antigen

The presence and distribution of hepatitis B core antigen (HBcAg) was studied in the liver of 227 chronic carriers of hepatitis B surface antigen (HBsAg) to investigate its relationship with serum HBV-DNA, the status of hepatitis B 'e' antigen/antibody (HBeAg/anti-HBe) and the underlying liver disease. HBcAg was detected in 144 of the 227 (63%) liver specimens and HBV-DNA in 132 (58%) of the corresponding sera. Serum HBV-DNA showed a constant link with intrahepatic HBcAg. Out of 96 HBeAg-positive patients, 91 (95%) had HBcAg in the liver and 85 (89%) had HBV-DNA in serum. Overall there was a significant link between HBeAg and HBV-DNA in serum, but there was no correlation in 58 out of 227 (26%) cases. In HBeAg/HBV-DNA-positive carriers, HBcAg expression was predominantly nuclear. It was nuclear and cytoplasmic in patients with the highest levels of viremia. Eleven out of 13 (85%) HBV-DNA-positive patients who had only cytoplasmic HBcAg were HBcAg-negative and had low levels of HBV-DNA. Nine of 13 (69%) patients with exclusively cytoplasmic HBcAg had severe chronic liver disease. Neither the presence of HBV-DNA and HBeAg in serum nor the nuclear localization of HBcAg were associated with the severity of liver damage. In the group of HBV-DNA-positive patients (132), the presence of liver disease was significantly connected with the absence of HBeAg in serum (P less than 0.05; C.L. 3-35).(ABSTRACT TRUNCATED AT 250 WORDS)     

911冲剂治疗乙型和丙型慢性病毒性肝炎疗效观察

据330例分组观察,治疗组HBV-DNA阴转率52.9％,对照组为16.7％;HBeAg阴转率和抗-HBe阳转率分别为76.8％和39.2％,对照组分别为19.5％和20.0％。综合评价治疗组的显效、有效与无效率分别为24.7％、42.9％与32.4％,而对照组为1.9％、38.8％与59.3％,故认为“911冲剂”对于HBV和HCV慢性感染可奏满意的治疗效果。     

自体与异体LAK细胞治疗慢性肝炎130例

目的对ＬＡＫ细胞治疗慢性肝炎作客观估价．方法治疗与对照组均口服维生素，肌注肝炎灵．治疗Ａ组加回输自体ＬＡＫ细胞，每周２次，６周为１个疗程；Ｂ组每周输注异体ＬＡＫ细胞悬液１次，５次为１疗程．结果ＬＡＫ细胞治疗慢性肝炎能使部分患者ＨＢｅＡｇ及ＨＢＶＤＮＡ阴转．治疗结束时ＨＢｅＡｇ阴转率Ａ组为４７５％，Ｂ组为５８０％；而对照组Ｃ为１５０％（Ｐ＜００５）．ＨＢＶＤＮＡ阴转率Ａ组为４５０％，Ｂ组为６６０％，而对照组Ｃ为１１８％，（Ｐ＜００５％）．结论ＬＡＫ细胞治疗对ＨＢＶ复制有明显抑制作用．异体ＬＡＫ组的ＨＢｅＡｇ及ＨＢＶＤＮＡ阴转率高于自体ＬＡＫ组．     

替比夫定与阿德福韦酯治疗慢性乙型肝炎的临床疗效比较

目的 比较替比夫定与阿德福韦酯治疗慢性乙型肝炎(CHB)48周的临床疗效和安全性.方法 选取2008年1月～2008年12月门诊44例CHB患者,应用替比夫定治疗,600 mg,1次/d,口服.同期30例CHB患者应用阿德福韦酯治疗,10 mg,1次/d,口服.均服用48周.观察48周血清丙氨酸转氨酶复常率、乙型肝炎病毒(HBV-DNA)阴转率、HBeAg阴转率和HBeAg血清转换率.并分别观察两组在12周、24周、36周的HBV-DNA阴转率、HBeAg阴转率.结果 48周替比夫定ALT复常率95.5%(42/44),HBV-DNA阴转率54.5%(24/44),HBeAg阴转率为27.3%(12/44),HBeAg血清转换率11.4%(5/44),阿德福韦酯分别为93.3%(28/30)、26.7%(8/30)、3.3%(1/30),未发生HBeAg血清学转换.替比夫定HBV-DNA在24周阴转率为47.7%(21/44),HBeAg在24周阴转率为25%(11/44),阿德福韦酯在24周HBV-DNA阴转率为13.3%(4/30),24周未发生HBeAg阴转.结论 替比夫定较阿德福韦酯有更快速、强效抗病毒作用,具有较高HBeAg阴转率和HBeAg血清转换率.     

Chronic carriers of hepatitis B virus in Bangladesh: a comparative analysis of HBV-DNA,HBeAg/anti-HBe,and liver function tests

Serological markers of hepatitis B virus (HBV), liver function tests and quantitative estimation of HBV-DNA are important in the assessment of the state of infection and prognosis following treatment for hepatitis B. This study aimed to determine whether low-cost assays, eg hepatitis B e antigen (HBeAg) and liver function tests, could be used for the assessment of infectivity as an alternative to HBV-DNA estimation. We tested 125 hepatitis B carriers for HBeAg, antibody to HBeAg (anti-HBe), and serum HBV-DNA; we also carried out a range of standard liver function tests. Seventy-three subjects were positive and 52 were negative for HBeAg. Of the HBeAg positive cases, 3 were also positive for anti-HBe; of the HBeAg negative cases, 5 were also negative for anti-HBe. Of these 8 cases, 7 had no detectable HBV-DNA. Most of the HBeAg positive but anti-HBe negative subjects were positive for HBV-DNA (74.3%; 52/ 70) whereas most of the HBeAg negative and anti-HBe positive subjects (93.6%; 44/47) were also negative for HBV-DNA. Of 56 HBV-DNA positive individuals, alanine transaminase (ALT) was found to be raised in 69.6% (p=0.066) and aspartate transaminase (AST) was raised in 66.1% (p=0.011), while 67.9% had normal alkaline phosphatase (ALP) (p=0.054). HBeAg (p=0.018) and raised ALT (p=0.008) were found to be independent predictors for HBV-DNA positivity among HBV carriers. This study suggests that HBeAg positive and anti-HBe negative hepatitis B carriers with raised ALT and AST are likely to be positive for HBV-DNA; the combination of routine serology and biochemical tests may be considered as an alternative to HBV-DNA in evaluating the state of chronic HBV infection. However, HBV-DNA should be specifically assessed if discordance is observed between seromarkers and transaminases.     

Efficacy of Pre-S-containing HBV Vaccine Combined with Lamivudine in the Treatment of Chronic HBV Infection

Treatment of chronic hepatitis B (CHB) is difficult. The response rate to interferon (IFN) as well as nucleoside analogs is not more than 30% in general. While interferon has many side effects, development of resistance in most of the nucleoside analogs precludes long-term use. Both groups of drugs are most efficacious in patients who already had or develop strong cellular immunity with treatment. A pre-S2-containing vaccine was shown to enhance cellular immunity and suppress hepatitis B virus (HBV)-DNA in subjects with chronic hepatitis B. We aimed to test the efficacy of short-term use of a nucleoside analog in combination with a pre-S2-containing vaccine in patients with CHB. In this open study, 48 consecutive patients (32 males and 16 females, mean age ± SD: 33 ± 12 years) with CHB without cirrhosis were treated with 100 mg/day lamivudine and four weekly intramuscular injections of Genhevac B 20 mcg (six doses) for 24 weeks. While 19 patients were hepatitis B e antigen (HBeAg) positive (+ve), 29 patients were Anti-HBe/HBV-DNA +ve at the outset. Response was defined as seroconversion to anti-HBe in HBeAg +ve subjects and normalization of alanine aminotransferase (ALT) with loss of HBV-DNA in anti-HBe/HBV-DNA +ve subjects. HBeAg seroconversion occurred in 5/19 subjects (26%). Eighteen of 29 anti-HBe/HBV-DNA +ves responded. In the follow-up, while relapse was not observed in any of the patients who seroconverted, 11/18 from the anti-HBe/HBV-DNA +ve group relapsed, resulting in a sustained response (SR) rate of 24% in this group. All the relapses happened in the first 48 weeks of follow-up, with no relapse thereafter. Pretreatment high serum HBV-DNA was a strong negative predictor of sustained response (SR) in HBeAg +ve group. Pretreatment serum ALT over 2 × upper limit of normal and HBV-DNA less than 200 pg/ml appeared positive predictors. None of HBeAg +ve previous interferon failures responded. Twenty-four weeks of lamivudine and hepatitis B vaccine treatment induces SR in around 1/4 of the patients with CHB. Most of the responders had high ALT and relatively low DNA.     

拉米夫定治疗晚期血吸虫病合并慢性乙型病毒性肝炎

目的 目的 探讨晚期血吸虫病合并慢性乙型肝炎患者应用拉米夫定 （LVD） 治疗的临床效果及对病程进展的影响。方 方 法 法 58例晚期血吸虫病合并慢性乙型肝炎患者随机分成治疗组 （30例） 和对照组 （28例）。治疗组服用LVD100 mg /d, 同时 给予常规综合治疗。对照组仅给予常规综合治疗, 随访时间为36 ± 3个月。 结果 结果 治疗组和对照组死亡率分别为13.33% 和55.56% （P < 0.01）, Child Pugh评分下降≥2分的患者分别为89.1%和62.3% （P < 0.05）。治疗组在降低血清胆红素和转氨 酶、 升高血清白蛋白水平、 改善肝功能方面均明显优于对照组 （P < 0.01）。治疗组HBV?DNA和HBeAg转阴率明显高于对 照组 （P < 0.01）。治疗组在12周时HBV?DNA转阴率为93.3%, 治疗组在48、 96、 144周时LVD发生TMDD变异率分别为 6.7%、 23.3%和40%。大多数发生变异的患者联合阿德福韦酯 （ADV） 治疗可抑制乙肝病毒复制, 肝功能保持相对稳定。 结 结 论 论 对晚期血吸虫病合并慢性乙型肝炎患者应用LVD治疗可以快速抑制乙肝病毒复制, 改善肝功能, 延缓病情进展。 LVD联合ADV可抑制大多数YMDD变异患者的病毒复制, 改善肝功能。     

Extended lamivudine treatment in patients with chronic hepatitis B enhances hepatitis B e antigen seroconversion rates: results after 3 years of therapy

A study in Chinese patients with chronic hepatitis B showed that treatment with lamivudine for 1 year significantly improves liver histology and enhances hepatitis B e antigen (HBeAg) seroconversion compared with placebo. Fifty-eight patients from this 1-year study have received long-term treatment with lamivudine 100 mg; the outcome of 3 years of lamivudine is reported here. Before treatment, all patients had detectable HBeAg. HBeAg seroconversion (HBeAg-negative, anti-HBe-positive), hepatitis B virus (HBV)-DNA suppression, alanine transaminase (ALT) normalization, emergence of YMDD variant HBV, liver histology, and long-term safety were assessed. After 3 years of continuous treatment with lamivudine 100 mg daily, 40% (23 of 58) of patients achieved HBeAg seroconversion. In patients with baseline serum ALT >2 x upper limit of normal (ULN), the rate of HBeAg seroconversion was 65% (17 of 26). Median serum HBV-DNA concentrations were below the level of detection, and median ALT concentrations were within the normal range throughout 3 years of treatment. YMDD variant HBV emerged in 33 of 58 (57%) patients during the 3 years, of whom 9 (27%) achieved HBeAg seroconversion (6 after emergence of YMDD variant HBV). ALT levels and histologic scores after emergence of YMDD variant HBV did not show major deterioration. Lamivudine was well tolerated during 3 years of therapy. In conclusion, these data in Chinese patients with chronic hepatitis B show enhanced seroconversion rates with extended lamivudine treatment. Up to two thirds of patients with moderately elevated pretreatment ALT achieved HBeAg seroconversion after 3 years of therapy.