拉米夫定治疗干扰素无应答慢性乙型肝炎的生化病毒指标和临床病理研究  

Biochemical and HBV Markers of Liver Biopsy in Chronic Hepatitis B Patients with Non-response to Interferon Treated with Lamivudine

作　　者：温帆渊[1] 谭斌[1] 李韶光[1] 杨小云[1] 吴静黎[1] 

机构地区：[1]惠州市中心人民医院广东医学院附属惠州医院,广东惠州516001

出　　处：《中华医院感染学杂志》2005年第8期861-863,共3页Chinese Journal of Nosocomiology

摘　　要：目的探讨拉米夫定治疗干扰素无应答慢性乙型肝炎2年前后血清生化、病毒指标和肝组织学变化。方法选择18例标准干扰素治疗慢性乙型肝炎无应答患者,口服拉米夫定100mg/d,连用2年;治疗前后,检测患者血清生化、HBV标志、肝组织活检,对炎症活动度和纤维化程度作计分评价。结果治疗后HBV DNA转阴率67%;HBeAg转阴率39%;HBeAg/抗HBe血清转换率28%;无HBsAg阴转;YMDD变异率44%;血清ALT、GGT、TBil水平明显改善,差异有显著意义(P<0.05);肝组织学炎症活动度计分由12.42±3.82降为7.64±3.07(P<0.05);纤维化程度计分由8.95±3.74降为6.48±3.02(P<0.05),差异有显著意义。结论拉米夫定长期治疗可有效抑制干扰素无应答慢性乙型肝炎患者HBV DNA复制,促进血清HBeAg转换,改善患者的肝功能,减轻患者的肝组织炎症和纤维化。OBJECTIVE To evaluate biochemical and HBV markers of liver biopsy in chronic hepatitis 13 patients with non-response to interferon treated with lamivudine. METHODS Eighteen chronic hepatitis B patients with non-response to interferon received 100 mg lamivudine orally daily for 2 years. The liver biopsies were obtained before and after treatment. The serum markers and the histological activity （HAI） and fibrosis score wereobserved. RESULTS The rate of HBV DNA seroclearance,HBeAg seroconversion and YMDD-motif mutants was 67％,28％ and 44％respectively. Lamivudine treatment was associated with a marked improvement in serum biochemical markers of bilirubin, ALT, and GGT （P〈0.05）. The HAI score reduced from 12.42±3.82 to 7.64±3.07 （P〈0.05） and fibrosis score reduced from 8.95±3.74 to 6.48±3.02 （P〈0.05） after treatment with lamivudine. CONCLUSIONS Long term lamivudine therapy could improve serum biochemical markers and HAI index, and reverse liver fibrosis.

关 键 词：慢性乙型肝炎 拉米夫定 Α干扰素 组织病理学 

分 类 号：R978.7[医药卫生—药品]