拉米夫定抗病毒治疗快速病毒学应答与一年疗效的相关性分析

目的分析慢性乙型肝炎（CHB）患者使用拉米夫定（LMD）抗病毒治疗后出现快速病毒学应答（RVR）对一年乙型肝炎病毒脱氧核糖核酸（HBVDNA）转阴率、乙肝病毒e抗原（HBeAg）血清转换率、丙氨酸转氨酶（ATJT）复常率和耐药发生率的预测价值，探讨临床实用的疗效预测指标。方法70例HBeAg阳性患者服用LMD抗病毒治疗4周时定量检测HBVDNA，将HBVDNA〈310g10cp／ml患者18例和HBVDNA≥310g10cp／ml患者52例作为I组和Ⅱ组分层观察，治疗52周时，检测血清HBVDNA，ALT，HBV血清标志物和HBV多聚酶氨基酸序列酪氨酸-蛋氨酸-天门冬氨酸-天门冬氨酸（YMDD）变异。结果治疗52周时的血清HBVDNA转阴率：I组为88．9％，Ⅱ组为44．2％；HBeAg血清转换率：I组为44．4％，Ⅱ组为11．5％；YMDD变异率：I组为0，Ⅱ组为21．2％；ALT复常率：I组为94．4％，Ⅱ组为76．9％。经统计学分析，HBVDNA转阴率、HBeAg血清转换率、YMDD变异率两组之间有显著差别。结论LMD治疗4周时出现RVR可预测一年疗效，并且有可能更好的指导临床医生合理使用核苷类似物治疗CHB。

The dependability analysis in a year of the rapid virological response in lamivudine antiviral therapy

Aim To analyze lamivudine effect on patients with chronic hepatitis B who show a rapid virology response. Methods Realtime PCR was used for detecting contents of HBV DNA when 70 patients take lamivudine for 4 weeks ,then 18 patients whose HBV DNA 〈31og10cp/ml were assigned group I ,52 patients whose HBV DNA ≥ 31og10ep/ml were assigned group Ⅱ. After a treatment of 52 weeks,detection was made for contents of HBV DNA , ALT, serum marker and YMDD mutation. Result After 52 weeks,trans - negative ratios of HBV DNA in group I and group Ⅱ were 88.9% ,respectively,HBeAg seroconversion rates in group I 44.4% ,group Ⅱ 11. 5% ,YMDD mutation rates in group I 0% ,group Ⅱ 21.2% ,ALT recovery rates in group I 94.4% ,group U 76.9%. There was significant difference between the two groups in the trans-negative ratios of HBV DNA, HBeAg seroconversion rates and YMDD mutation rates. Conclusion We can predict efficacy of the year after four weeks of lamivudine treatment of patients with chronic hepatitis B who show a rapid virology response, and it is helpful for rational use of nucleoside analogues.