HBeAg阳性儿童慢性乙型肝炎的临床治疗

目的 评价拉米夫定联合左旋咪唑涂布剂治疗HBeAg阳性儿童慢性乙型肝炎的近、远期疗效,以探讨治疗儿童慢性乙型肝炎的有效方法.方法 采用统一检测方法和评价标准,分析拉米夫定联合左旋咪唑涂布剂治疗HBeAg阳性的儿童慢性乙型肝炎(儿童组)的近期疗效、HBV YMDO发生率及停药后的远期疗效,并与同期治疗的HBeAg阳性成人慢性乙型肝炎(A组:拉米夫定+左旋咪唑涂布剂与B组:单用拉米夫定)的相关指标比较,进行X2检测.结果 儿童组与成人A组及成人B组治疗结束时,血清学、病毒学、生化学单项应答率分别为52.4%:34.0%:28.5%;90.5%:74.9%:62.8%;85.7%:82.9%:75.9%;完全应答率分别为52.4%、32.0%、25.5%;HBV YMDD变异率分别为14.3%、18.0%、32.1%;停药后1年持久应答率分别为90.9%、75.0%、51.4%.儿童组与成人A组各项疗效差异均无统计学意义,疗效基本相同,完全应答率虽优于成人A组,但差异无统计学意义.儿童组与成人B组相比,血清学、病毒学应答率、联合应答完全应答率及1年持久应答率均显著优于成人B组(P<0.05),而其他各项疗效差异均无统计学意义(P>0.05).结论 对ALT≥正常上限2倍的儿童慢性乙型肝炎,拉米夫定联合左旋咪唑涂布剂治疗的近远期疗效均明显优于单用拉米夫定者.

Clinical treatment for children with HBeAg positive chronic hepatitis B

Objective To analyze the therapeutic effect of chronic hepatitis B of HBeAg positive children by combination of lamivudine and liniment levamisole, to explore the suitable treatment of chronic hepatitis B of children. Method By adoptting the uniform detection and evaluation, to analyze the treatment for children with HBeAg positive chronic hepatitis B (group of children) by combination of lamivudine and liniment levamisole in the near future, the rate of occurrence of HBV YMDD and the curative effect of far future when stopping treatment, and to be compared with the corresponding index of the treatment in the adults of group A(lamivudine + liniment levrmisole) of HBeAg positive and the adults of group B(lamivudine only) at the same time through χ2 test. Results At the end of the treatment, the group of children and group A and group B, the single responding rate of serology and virology, biochemistry were 52.4%:34.0%:28.5%; 90.5%:74.9%:62.8%;85.7%:82.9%:75.9% respectively; the complete responding rate was 52.4%, 32.0%, 25.5%; the rate of occurrence of HBV YMDD was 14.3%, 18.0%, 32.1%; while stopping treatment for 1 year,the persistence responding rate were 90.9%, 75.0%, 51.4%. There were no statistical differences in all kinds of the creative effects in the group of children and group A of adults. The complete responding rate in the gronp of children was higher than that in group A of adults, but there was no statistical difference. By compering to the group B of adults, the single responding rate of serology and virology, the complete responding rate and the 1 year's persistence responding in the group of children were all much higher(P<0.05), there were no statistical differences in all of the other curative effects(P>0.05).Conclusions For the chronic hepatitis B of children (the ALT is more than or equal to the normal upper limit), the complete responding and the curative effects of lamivudine and liniment levamisole are better than by using larnivudine only.