拉米夫定并干扰素α对HBeAg阳性慢性乙型肝炎效果

目的评价拉米夫定（LMD）并干扰素α（IFNα）治疗HBeAg阳性慢性乙型肝炎（CHB）的效果。方法将160例HBV-DNA和HBeAg阳性的CHB病人随机分为A、B、C共3组。A组给予LMD 100 mg/d,联用IFNα5 MU,3次/周;B组单用LMD 100 mg/d;C组单用IFNα5 MU,3次/周,3组均12个月为一疗程。3组均在6个月及疗程结束时进行疗效评价。结果治疗6个月时,A组HBeAg转阴率、HBeAg/抗-HBe血清转换率均显著高于B组,差异有显著性（χ2=9.646、11.332,P〈0.05）;A组丙氨酸氨基转移酶（ALT）复常率显著高于C组,差异有显著性（χ2=24.158,P〈0.05）。疗程结束时,A组HBeAg转阴率、HBeAg/抗-HBe血清转换率均显著高于B组,差异有显著意义（χ2=15.684、13.907,P〈0.05）,A组酪氨酸-蛋氨酸-天门冬氨酸-天门冬氨酸（YMDD）变异率明显低于B组,差异有显著意义（χ2=5.688,P〈0.05）;A组ALT复常率、HBV-DNA转阴率、HBeAg转阴率、HBeAg/抗-HBe血清转换率均明显高于C组,差异有显著意义（χ2=5.649~7.016,P〈0.05）。结论 LMD联合IFNα是HBeAg阳性CHB病人安全而较有效的治疗方法,其YMDD变异率低于单用LMD,疗效明显优于单用LMD或IFNα。

EFFECT OF LAMIVUDINE COMBINED WITH ALPHA INTERFERON ON PATIENTS WITH CHRONIC HBeAg-POSITIVE HEPATITIS

Objective To evaluate the efficacy of lamivudine（LMD） combined with alpha interferon（IFNα） on patients with chronic HBeAg-positive hepatitis B（CHB）. Methods This study consisted of 160 CHB patients,with both HBV-DNA and HBeAg positive,who were randomly divided into groups A,B and C.The patients in group A received IFNα 5 MU,three times a week plus LMD 100 mg/d;those in group B received LMD 100 mg/d alone;and those in group C received IFNα 5 MU alone,three times a week.The course of treatment lasted for 12 months.The curative effect was assessed six months and upon completion of the trial. Results After six months of therapy,in group A,the negative-returning rate of HBeAg and frequence of seroconversion of HBeAg/anti-HBe were significantly higher than those in group B（χ2=9.646,11.332;P0.05）;the normal-returning rate of alanine aminotransferase（ALT） was significantly higher than in group C（χ2=24.158,P0.05）.Upon completion of the course,in group A,the rates of negative-returning of HBeAg and seroconversion of HBeAg/anti-HBe were higher,and the tyrosine-methionine-aspartate-aspartate（TMAA） mutation rates were lower than that in group B（χ2=5.688,P0.05）,the normal-returning rate of ALT,HBV-DNA,HBeAg,and frequence of seroconversion of HBeAg/anti-HBe were all higher than that in group C（χ2=5.649-7.016,P0.05）. Conclusion Combination therapy with LMD and IFNα,with its lower YMDD mutation than using LMD alone,is effective and safe for HBeAg-positive CHB patients,which is superior to monotherapy with LMD or IFN.