阿德福韦酯治疗慢性乙型肝炎疗效及对血清学应答的影响

目的探讨阿德福韦酷治疗慢性乙型肝炎的疗效及其影响因素。方法 240例慢性乙型肝炎患者,随机分为治疗组(200例)和对照组(40例)。2组均给予常规保肝治疗。治疗组在此基础上加用阿德福韦酷治疗。2组均治疗48周,动态观察4、8、16、24、48周HBV-DNA转阴率及HBV-DNA下降水平。对治疗组行肝组织病理学检查,并依据肝脏炎症程度将其分为3组,检测其48周后HBV-DNA转阴率及HBV-DNA下降水平。结果 (1)阿德福韦酯治疗48周,治疗组HBV-DNA转阴率明显高于对照组,从第8周开始差异有统计学意义。(2)治疗组中,不同的时间段HBV-DNA转阴率及HBV-DNA下降拷贝数与17～24周相比差异有显著性(P<0.05)。(3)肝脏炎症程度G1～2、G3组HBV-DNA转阴率及HBV-DNA下降拷贝数明显低于G4组(P<0.05)。结论慢性乙型肝炎肝脏病理对阿德福韦酯抗病毒治疗过程可能起着重要作用。

Role of pathology in treatment of chronic hepatitis B liver with adefovir dipivoxil

Objective To investigate the efficacy of adefovir dipivoxil in patients with chronic hepatitis B and the correlating factors associated with therapeutic efficacy.Methods 240 cases of chronic hepatitis B patients were randomly divided into a treatment group（n=200） and a control group（n=40）.The patients in the treatment group were given adefovir dipivoxil treatment on the basis of conventional therapy;those in the control group were using conventional therapy only.The study of the two groups was completed in 48 weeks.HBV-DNA negative rate and HBV-DNA decreasing levels were observed at the 4th,8th,16th,24th,and 48th week respectively.Histopathological examinations were performed in the treatment group.Patients in the group were re-divided into three groups according to liver inflammation classification.After 48 weeks,HBV-DNA negative rate and HBV-DNA decreasing levels were tested.Results ①There were significant differences in the HBV-DNA negative rate between the treatment group and the control group at the 8th,16th,24th,and 48th week（P〈0.05）.②In the treatment group,remarkable difference occurred in different time spans compared with the period between the 17th and 24th week in terms of the HBV-DNA negative rate and the median decrease in serum HBV-DNA levels.③HBV-DNA negative rate and median decrease in serum HBV-DNA levels in the groups of G1-2 and G3 were significantly lower than those of the G4 group（P〈0.05）.Conclusion Pathology of chronic hepatitis B liver may play an important role in adefovir dipivoxil treatment.