HBsAg定量预测拉米夫定治疗e抗原阳性慢性乙型肝炎的远期疗效

目的通过分析血清中HBsAg水平同e抗原血清转换率间的关系来确定拉米夫定治疗e抗原阳性慢性乙型肝炎（CHB）的远期疗效。方法将60例慢性乙型肝炎（CHB）患者按HBsAg水平〈100、100～200、〉200 ng/L分为3组作为治疗组,进行拉米夫定抗病毒12个月的治疗。对照组15例CHB患者不给予拉米夫定抗病毒治疗,按照HBsAg水平〈100、100～200、〉200 ng/L分为3组,均给予门冬氨酸钾镁、维生素C、复方甘草酸制剂等一般保肝对症治疗,观察治疗终点时三个水平拉米夫定治疗组和对照组e抗原的血清转换率和HBV DNA阴转率。明确e抗原的血清转换率与HBsAg初始水平和治疗3个月时下降幅度的关系。从而确定HBsAg定量检测用于预测拉米夫定治疗e抗原阳性慢性乙型肝炎的远期疗效的诊断价值。结果治疗终点时,三个水平的拉米夫定治疗组与对照组其e抗原的血清转换率分别为58.6%、37.8%、20.6%和5.1%;HBV DNA阴转率则分别为71.0%、34.9%、23.6%和0。e抗原血清转换率同HBsAg初始水平与治疗3个月时相比差异有统计学意义（P〈0.05）。结论 HBsAg初始水平或治疗3个月后下降幅度是获得较高e抗原的血清转换率较好的预测指标,有助于指导临床用药。

HBsAg quantitative prediction of long-term curative effects of Lamivudine in treatment of HBeAg positive chronic hepatitis B

Objective To determine the long-term curative effects of Lamivudine in the treatment of HBsAg positive chronic hepatitis B(CHB) through analyzing the relationship between the serum HBsAg level and the HBeAg seroconversion rate.Methods 60 patients with CHB were divided into 3 treatment groups according to the HBsAg levels<100,100-200 and >200 nL and received 12 months of Lamivudine antiviral treatment.15 patients with CHB of the control group received potassium magnesium aspartate,Vitamin C,compound licorice acid preparation and other general liver protection symptomatic treatment instead of the Lamivudine antiviral treatment and were divided into 3 groups according to the HBsAg levels<100,100-200 and >200 nL.The HBeAg seroconversion rates and the HBV DNA negative conversion rates of the treatment groups in three different Lamivudine levels and the control group at the end point of treatment were observed.The relationship between the HBeAg seroconversion rate and the initial level of HBsAg and its decline degree at the third month of treatment was determined.Thus the diagnostic value of HBsAg quantitative detection in the application of predicting the long-term curative effects of Lamivudine in the treatment of HBsAg positive CHB was determined.Results At the end point of treatment,the HBeAg seroconversion rates of the treatment groups in three different Lamivudine levels and the control group were 58.6%,37.8%,20.6% and 5.1% respectively;and the HBV DNA negative conversion rates were 71.0%,34.9%,23.6% and 0 respectively.The HBeAg seroconversion rate was significantly different from the initial HBsAg level and the HBsAg level at the third month of treatment(P < 0.05).Conclusion The initial HBsAg level and its decline degree at the third month of treatment are good predictive indicators of obtaining high HBeAg seroconversion rate and conducive to guiding clinical medication.