慢性乙型肝炎拉米夫定治疗后的HBeAg早期血清转换

目的:分析拉米夫定与中成药五灵丸治疗慢性乙型肝炎的临床疗效。方法:对25例成人慢性乙型肝炎患者进行为期1年的拉米夫定的开放性临床治疗,头3个月加用五灵丸。治疗期间定期进行血清ALT、HBeAg、抗-HBe及HBV DNA检测,停药后随访半年。结果:治疗期间共有12例患者(48％)发生HBeAg转阴,并出现抗-HBe;在HBeAg血清转换后的2～4w,8例患者抗-HBe随后消失;在治疗的头3个月随着HBV DNA水平下降及消失(<420copies/ml),所有患者ALT水平逐渐降至正常。结论:治疗头3个月是应用拉米夫定治疗患者HBeAg发生血清转移的关键。这种早期转换的可能解释之一是慢性乙肝患者存在对拉米夫定特别敏感的亚型或种群。

Early Hepatitis B e Antigen Seroconversion after Lamivudine Therapy in Patients with Chronic Hepatitis B

Objective: To evaluate the clinical effect of Lamivudine and herbal compound Wulinwan to chronic hepatitis B. Methods: A one-year trail of Lamivudine combined 3 months therapy of herbal compound Wulinwan was be done for 25 adult patients with chronic hepatitis B. Routine laboratory tests taken on each clinic visit included serum transami-nase ,HBeAg,anti-HBe and HBV DNA. These patients were followed up for six months after the end of therapy. Results: During the trament, 12 patients (48%) had HBeAg/anti-HBe seroconversion and among them there were 10 patients lost HBeAg within first 3 months therapy and developed anti-HBe. and then there were 8 patient lost anti-HBe gradually within 2-4 weeks. Serum ALT level also fell during first 3 months,generally following the decrement of HBV DNA level. Conclusion: The results suggested that first three months is the critical phase for early seroconversion of HBeAg in Lamivudine therapy. This maybe due to the quasispecies of the HBV that specially sensitive to Lamivudine.