拉米夫定治疗干扰素无应答HBeAg阳性慢性乙肝患者的疗效

目的:观察拉米夫定(lamivudine,LMV)对干扰素治疗无应答HBeAg阳性的慢性乙型肝炎患者的疗效。方法:73例干扰素治疗无应答患者停药后改用LMV100mg,q.d,口服(研究组),同期的82例为LMV初治患者(对照组),比较两组24月治疗期间和停药6月后血液生化学、HBV血清学及其分子生物学指标的变化。结果:研究组(73例、56例和42例)与对照组(82例、63例和45例)分别完成了LMV12,18,24月的治疗,研究组和对照组停药随访6月以上的患者分别为26例、19例。在24月的治疗后,两组ALT复常率和HBV-DNA阴转率未见显著性差异(P>0.05);研究组在LMV治疗6月与18月后,HBeAg的消失率与血清转换率均显著高于对照组(P<0.05);24月治疗后,研究组和对照组HBsAg的消失率分别为11.90%和2.22%,但未达到统计学差异(P>0.05);而研究组和对照组HBV-YMDD的累积变异率分别为16.44%和31.71%,均具有显著性差异(P<0.05);停药6月后研究组和对照组病毒学复发率分别为11.54%和21.05%,差异尚无统计学意义(P>0.05)。结论:LMV对干扰素治疗无应答的慢性乙肝疗效确切,其疗效显著优于LMV初治的患者。

Efficacy of Lamivudine Therapy for HBeAg-positive Chronic Hepatitis B in Interferon Nonresponders

Objective： To investigate the efficacy of lamivudine theapy for HBeAg-positive chronic hepatitis B in interferon nonresponders. Methods： Lamivudine 100 mg daily was individually given to 73 interferon nonresponders（but one aged 8 received 50 mg ） （studying group） and 82 antiviral treatment-naive patients （control group）. Serum biochemical, HBV serum immunological as well as molecular biological indexes were compared between the studying and control groups during the 24 months of treatment and 6 months of follow-up. Results： In studying group, 73, 56 and 42 cases of patients received lamivudine treatment for 12, 18 and 24 months, respectively, while the corresponding cases were 82, 63 and 45, respectively, in control group. On completing with 24-month treatment, the patients who were followed up for more than 6 months were 26 in studying group and 19 in control group. The normalization of ALT and undetectability of HBV-DNA were not remarkably significant between the two groups during 24-month therapy （P 〉 0.05）. At month 6 and from then on, HBeAg loss was markedly higher in studying group than in control one （P〈 0.05）. At month 18 and also from then on, HBeAg seroconversion was also significantly higher in studying group than in control one （P〈 0.05）. At month 24, the overall HBsAg loss was 11.90% in studying group, while it was 2.22% in control one, but there was no significant difference （P 〉 0.05）. The accumulative YMDD mutation was 16.44% in studying group and 31.71% in control one, and there was remarkable difference between the two groups （P〈 0.05）. The virological breakthrough was 11.54% in studying group and was not markedly different compared with 21.05% in control one （P 〉 0.05） during the 6-month follow-up. Conclusion： Lamivudine is effective in HBeAg-positive chronic hepatitis B patients who are nonresponders to interferon, and its efficacy is distinctly superior to lamivudine treated patients naive to interferon.