拉米夫定治疗慢性乙型肝炎HBV DNA阴转疗效影响因素研究

目的探讨拉米夫定治疗慢性乙型肝炎患者疗效的影响因素。方法对拉米夫定治疗的慢乙肝202例和乙型肝炎肝硬化（简称乙肝肝硬化）55例患者，采用聚合酶链反应及错配聚合酶链反应限制性片段长度多态性分析的方法检测HBV DNA及乙型肝炎病毒（HBV）聚合酶YMDD变异，应用SPSS统计软件对基线ALT、AST、TBIL、白蛋白、球蛋白、HBeAg（高、中、低）、HBV DNA等共10个变量作为处理因素进行统计学检验。结果随治疗时间的延长，慢乙肝和肝硬化者HBV DNA的阴转率于3、6、12、18、24、30个月分另1为87．62％、95．04％、86．63％、82．65％、75．43％、77．27％和94．54％、98．18％、81-81％、74．35％、73．91％、63．63％，时序检验及Cox回归分析结果表明：联合干扰素、基线ALT水平较高、HBV DNA水平较低和基线白蛋白水平较低，与HBV DNA转阴率高相关。结论联合干扰素、基线ALT水平较高、HBV DNA水平较低和基线白蛋白水平较低可作为HBV DNA转阴的预测因素。

Predictive factors of hepatitis B virus DNA negative conversion among patients with chronic hepatitis B during lamivudine therapy

OBJECTIVE: To study the occurrence and predictive factors of hepatitis B virus DAN negative conversion among patients with chronic hepatitis B and liver cirrhosis during lamivudine therapy. METHODS: Clinical data of 202 patients with chronic hepatitis B and 55 patients with post-hepatitis B cirrhosis treated with lamivudine therapy were analyzed and PCR as well as mispairing PCR-restricted fragment length polymorphism (RFLP) assay were applied. The data including ALT, AST, total bilirubin (TBIL), albumin, etc. were analyzed by SPSS software. RESULTS: The HBV DNA negative conversion occurred in 87.62%, 95.04%, 86.63%, 82.65%, 75.43%, and 77.27% of the chronic hepatitis B patients and in 94.54%, 98.18%, 81.81%, 74.35%, 73.91%, and 63.63% of liver cirrhosis patients, respectively, after 3, 6, 12, 18, 24, 30 months. The results of log-rank test and Cox proportional hazard model analysis indicated that combination of lamivudine and interferon, high ALT level,low HBV DNA level, and low albumin level at baseline were significantly related to HBV DNA negative conversion. CONCLUSION: Combination treatment with lamivudine and interferon, high ALT level, low HBV DNA level, and low albumin level at baseline were significant predicting predicting factors for HBV DNA negative conversion in chronic hepatitis B patients.