拉米夫定治疗e抗原阴性慢性乙型肝炎疗效观察

目的观察拉米夫定治疗e抗原阴性慢性乙型肝炎的疗效。方法对32例e抗原阴性慢性乙型肝炎患者用拉米夫定治疗，4l例患者用护肝药作对照，疗程2年以上，疗效评估包括肝功能和HBV复制指标。结果拉米夫定治疗24个月后，肝功能的复常率明显优于护肝治疗组（84．3％对58．54％，P〈0．05），HBV DNA转阴率显著优于护肝治疗组（81．25％对14．63％，P〈0．01）。拉米夫定治疗9个月开始出现YMDD变异，24个月时YMDD变异率为15．63％，YMDD变异后2例肝功能再次出现异常。护肝治疗组3个月后，随着疗程的延长肝功能的复常率无明显增加。结论拉米夫定对e抗原阴性慢性乙型肝炎有较好的治疗作用，出现变异耐药后需要更换其他抗病毒药物。护肝治疗3个月无效者需要进行抗病毒治疗。

Treatment response to lamivudine in patients with HBeAg negative chronic hepatitis B

Objective To investigate the efficacy of lamivudine on patients with HBeAg negative chronic hepatitis B. Methods 32 patients with HBeAg liver-protecting drugs.negative chronic hepatitis B were treated with lamivudine, and 41 patients were treated with. The treatment duration was two years. Results After 24 months of treatment, the percentage of patients with normalization of alanine aminotransferase levels and HBV DNA levels below 1 000 copies per milliliter were significantly higher with lamivudine therapy (84.3% and 81.25%, respectively)than with liver protective therapy(58.54%, P<0.05 and 14.63%,P<0.01).At 9 months, HBV YMDD mutation was deteced. At 24 months, HBV YMDD mutation rate was 15.63%. Two in five patients with HBV YMDD mutation become alanine aminotransferase abnormal. After 3 months of liver protective treatment, the percentage of patients with normalization of alanine aminotransferase levels in creared. Conclusion Patients with HBeAg negative chronic hepatitis B response well to lamivudine treatment. It is necessary to switch to other antiviral drug after HBV YMDD mutation. After 3 months, patients unresponsive to liver protective treatment need to be switch to antiviral drug treatment.