慢性乙型肝炎抗病毒治疗疗效及因素研究

目的调查北京地区不同抗病毒药物治疗慢性乙型肝炎(慢性乙肝)患者的疗效及差异、影响因素和不良反应情况。方法采用回顾性前瞻研究的方法,调查随访1995—2002年在北京佑安医院,北京大学第一医院,解放军302医院及地坛医院确诊并经抗病毒治疗或未抗病毒但随访观察的慢性乙肝患者1 489例。比较应用4种抗病毒药物的治疗效果及影响因素。结果①北京地区干扰素和拉米夫定治疗覆盖率约40%,高于国内平均水平。②4种抗病毒药物中以干扰素和拉米夫定疗效较好。拉米夫定对乙型肝炎病毒(HBV)DNA的抑制作用明显,但出现停药反跳,E系统转换率较低(13.3%)。干扰素组E系统转换率相对较高(22.9%),且疗效持久,但不良反应多见。③统计分析提示治疗前血清丙氨酸转氨酶(ALT)水平高、乙肝病毒载量低者对治疗反应性好。④对抗病毒治疗常见的不良反应认知和处置能力较好,但半数病例缺乏对血糖、甲状腺功能、自身抗体等的定期监测。结论鉴于目前抗病毒药物单独应用的疗效十分有限,有必要开展针对慢性乙肝的前瞻性研究,探讨更有效抗病毒治疗的方法和疗效预测因素,以提高疗效、改善慢性乙肝的不良预后。同时应加强对抗病毒治疗中不良反应的认知和监测,以保证治疗的安全性。

Study on the Efficacy and Related Factors of Antiviral Therapy in Chronic Hepatitis B

Objective To investigate the efficacy and related influence factors and side effects of different antiviral drugs.Methods Retrospective study was performed,1()489 patients who were diagnosed chronic hepatitis B in the following hospitals(Beijing You'an Hospital,the First Hospital,Beijing University,The No.302 Hospital of the People Liberation Army and Beijing Ditan Hospital) and treated with antiviral drugs from 1995 to 2002,were followed.Antiviral efficacy of the four drugs and related factors were compared.Results 1) Forty percent of the patients were treated with antiviral drugs,which were higher than other regions in China.2) Of all the four drugs,interferon and lamivudine had better efficacy than the other drugs.Lamivudine can suppress HBV DNA effectively,but after stoping treatment,the HBV DNA level rebounded.The serum conversion rate of HBeAg/HbeAb was very low(13.3%).Interferon group was much better(22.9%) and lasted for long time although the side effects were more than other groups.3) Statistics showed that the patients with the high ALT and low HBV DNA level before treatment had better response to antiviral treatment.4) Most of the patients and doctors recognized the side effects,but glucose,hypothyroid function,auto-antibodies were not tested in about half of the patients.Conclusion Because of the limited effects of single antiviral drugs,it is very necessary to carry out prospective research to investigate more effective antiviral methods and the predicted factors to improve the prognosis of hepatitis.At the same time,we should pay much alternation to the side effects to ensure the treatment safety.