早期病毒学应答是评估拉米夫定治疗慢性乙型肝炎疗效的重要指标  

Early HBV DNA response is an important predictor for lamivudine treatment of patients with HBeAgpositive chronic hepatitis B

作　　者：姚履枫[1] 朱琪[2] 林彩文 张平[1] 胡盈莹[1] 江家骥[3] 

机构地区：[1]福州市传染病医院,350025 [2]福州市第二医院 [3]福州市传染病医院 [4]不详

出　　处：《实用肝脏病杂志》2007年第1期8-11,共4页Journal of Practical Hepatology

基　　金：福建省科技重大专项课题项目基金资助(2004YZ01-3);福州市科技发展基金资助项目(2002-15)

摘　　要：目的观察拉米夫定治疗HBeAg阳性慢性乙型肝炎病人的疗效及影响因素。方法336例HBeAg阳性慢性乙型肝炎病人予以拉米夫定100mg每日一次口服治疗9月～24月。疗效评估包括血清学、病毒学、血生化学和综合应答。结果血生化学应答率为86.6%(291/336),治疗前ALT水平与血清HBeAg/抗-HBe血清转换呈正相关,从高至低依次为治疗前ALT≥5倍组>ALT2～5倍组>ALT≤2倍组。HBV DNA应答率与疗程有关,治疗6～9月时完全应答率最高为75.0%～74.7%,后随疗程延长转阴率下降,依次9月时为74.7%>12月时69.8%>18月时61.7%>24月时61.2%。治疗前HBV DNA水平≤1×106copies/ml者血清HBeAg/抗-HBe血清转换率高于HBV DNA>1×106copies/ml者,治疗24月时两组比较有显著差异(P<0.05)。性别、年龄、病程与HBV DNA转阴无显著相关(P>0.05)。早期治疗3月无应答者16例延长疗程至6月时2例发生完全应答占12.5%、9月时3例完全应答18.8%,延长疗程至12月、18月时无新增完全应答病例。YMDD变异发生率随疗程延长而增加。结论基线ALT水平显著升高、HBV DNA水平较低是HBeAg/抗-HBe血清转换的重要预测指标。治疗6～9月的疗效在一定程度上可看作是判断远期疗效的标准。治疗6～9月无应答者应考虑改用或联合其它药物治疗。Objective To evaluate the efficacy and affecting factors of lamivudine treatment for patients with hepatitis B e antigen （ HBeAg）-positive chronic patitis B. Methods 336 patients received lamivudine 100 mg once daily for 9 to 24 months. Therapeutic effect evaluation involved the serum HBV DNA level, HBeAg/HBeAb sero-conversion and biochemical response. Results Biochemical response ： normal alanine aminotransferase （ALT） was seen in 86. 6 % （291/ 336） and aspatate aminotransferase （AST） 87. 5 % （294/336） ; HBeAg/HBeAb sero-conversion was correlated with pretherapy ALT levels; HBeAg/HBeAb sero-conversion was distinct different in group ALT ≥5 × ULN than in group ALT 2× ULN （P〈0. 05）; HBV DNA level was correlated with period of lamivudine treatment and HBV DNA negative was 75. 0%～74. 7% at month of 6 to 9. Undetectable HBV DNA level was distinct different at month of 6 than at month 18 （P 〈0. 01） and at month of 9 than at month of 24 （P〈0. 05）; HBeAg/HBeAb sero-conversion was higher in group with pre-therapy HBV DNA level ≤1 × 10^6 copies/ml than in group with ≥1×10^6 copies/ml. Age and course of disease was correlated with HBV DNA loss （P 〉0. 05）. YMDD mutants were detected with period of lamivudine treatment, which was distinct different at month of 9 than at monthl8 （P〈0. 01）. Conclusion The serum pre-therapy higher ALT levels and lower HBV DNA level was an important index of HBeAg / HBeAb sero-conversion in patients with larnivudine treatment. At 6 to 9 month of lamivudine treatment, the serum HBV DNA level was a predictor of the larnivudine treatment.

关 键 词：乙型肝炎 拉米夫定 应答 

分 类 号：R512.62[医药卫生—内科学]