联合核苷类药物治疗干扰素应答不佳的慢性乙型肝炎时机选择及疗效研究

目的：探讨干扰素治疗HBeAg阳性慢性乙型肝炎时，联合核苷（酸）类药物的不同时机对治疗应答的影响。方法：观察干扰素治疗患者分别在治疗起始时联合阿德福韦酯、12周应答不佳者及24周应答不佳者联合拉米夫定最终各组疗效。结果：48周时及停药后24周时，起始时联合阿德福韦酯治疗组及12周应答不佳者联合拉米夫定组患者的病毒转阴率、 ALT复常率、 HBeAg转阴率均高于对照组（ P＜0.05），而HBeAg转换率并未有明显提高（ P＞0.05）。结论：治疗起始干扰素联合阿德福韦酯或根据12周应答情况加用拉米夫定治疗均能一定程度提高治疗应答率。

The opportunity and effect of nucleoside analogue combined with interferon for treating chronic hepatitis B virus infection

Objective： To observe the efficacy and the opportunity of nucleoside analogue combined with interferon in treat -ment of HBeAg-positive chronic hepatitis B patients.Methods： Ninety two cases of HBeAg -positive chronic hepatitis B pa-tients were divided into 4 groups： interferon monotherapy group （ n =25 ） , interferon plus ADV de novo combination therapy group （ n=25 ） , interferon plus LAM combination therapy at 12 weeks group （ the patients without early viral responses , n=22）, interferon plus LAM combination therapy at 24 weeks group （the patients without virological response , n=20） .All pa-tients were treated with inteferon for 48 weeks.The percents of HBeAg clearance or seroconversion , ALT normalization and un-detectable HBV DNA were evaluated.Results： Compared with interferon monotherapy group , the percentages of HBeAg clear-ance, undetectable HBV DNA and ALT normalization in ADV combination therapy group or LAM combination therapy at 12 weeks group was significantly improved , however , no difference of HBeAg seroconversion occurrences among these three groups .Conclusion：Efficacy of adefovir dipivoxil combination with interferon therapy or lamivudine combination with interferon at 12 weeks therapy is superior to interferon monotherapy in HBeAg -positive chronic hepatitis B patients.