拉米夫定和泛昔洛韦联合治疗慢性乙型肝炎的临床疗效观察

目的　观察拉米夫定和泛昔洛韦联合治疗慢性乙型肝炎并与单用拉米夫定进行比较 ,探讨其联合治疗效果。方法　 6 8例 HBV DNA阳性慢性乙型肝炎患者分两组分别接受核苷类药物治疗 ,30例单用拉米夫定 1 0 0mg,每日 1次 ,共 4 8周 ;38例拉米夫定和泛昔洛韦联合治疗 ,其中拉米夫定 1 0 0 m g,每日 1次 ,泛昔洛韦 5 0 0 m g,每日3次 ,8周后改为 2 5 0 mg,每日 3次 ,共 2 4周 ,观察至 4 8周。每例病例均有治疗前后系列血清标本检测肝功能、HBVDNA和 HBV标志物 ,分析比较两组在治疗前后的指标变化情况。结果　两组均无明显副反应。联合治疗组 AL T复常时间 (从 1 8周下降 ,2 4周复常 )较单用拉米夫定组 (6周下降 ,1 8周复常 )慢 ,正常 AL T水平两组均持续至 4 8周。联合治疗组 HBV DNA阴转率 85 .6 %好于单用组 77.8% (P<0 .0 5 ) ,HBe Ag/抗 - HBe血清转换率联合组 2 8.9%高于单用组 3.3% (P<0 .0 1 ) ,且可维持至 4 8周。单用组有 6例 YMDD阳性 ,联合治疗组无。结论　与单用组比较 ,拉米夫定与泛昔洛韦联用治疗慢性乙型肝炎 ,可提高 HBV DNA的阴转率、HBe Ag/抗 - HBe的血清转换率 ,且可维持一段时间 ,减少 YMDD变异

Clinical study of chronic hepatitis B treated with combination of lamivudine and famciclovir

Objective To observe the effect of lamivudine and famciclovir on chronic hepatitis B and compare the curative effect with that of lamivudine alone.Methods Chronic hepatitis B infected patients were treated with lamivudine only(30 cases,100 mg daily for 48 weeks) or lamivudine plus famciclovir 38 cases,100 mg lamivudine daily for 48 weeks plus famciclovir daily for 8 weeks in 500 mg and then for 16 weeks in 250 mg).The liver function,serum HBV DNA,serum HBV markers were detected in both groups and the results were compared.Results The period of ALT decreasing in the combination therapy group was more slowly than that in lamivudine treated group.The rates of HBV DNA negative conversion(85.6%)and HBeAg/anti HBe conversion in the combination therapy group were significantly higher than those in lamivudine treated group,which coun last for 48 weeks.There were 6 cases of YMDD mutation in the combination therapy group.Conclusion Combination therapy of lamivudine and famciclovir has higher effect than that in lamivudine therapy alone on negative conversion of HBV DNA and conversion of HBeAg/anti HBe.