恩替卡韦治疗拉米夫定失效慢性乙型肝炎的疗效预测初探  

Week 24 suppression of EIBV in entecavir-treated chronic hepatitis B patients in whom lamivudine treatment failed is associated with efficacy at week 48

作　　者：马红[1] 任江波[1] 李红艺[1] 王宇[1] 王瑞丽[1] 梁丽[1] 孙淑杰[1] 贾继东[1] 

机构地区：[1]首都医科大学附属北京友谊医院肝病中心,100050

出　　处：《中华实验和临床病毒学杂志》2007年第2期102-104,共3页Chinese Journal of Experimental and Clinical Virology

摘　　要：目的观察恩替卡韦治疗拉米夫定失效慢性乙型肝炎24周时对HBV的抑制程度，与治疗48周疗效之间的关系，探讨临床实用的疗效预测指标。方法拉米夫定治疗失效慢性乙型肝炎患者33名，采用恩替卡韦每日1．0mg治疗。根据治疗24周时血清HBVDNA的水平，将患者分为4组：PCR低于检测下限（QL）组（〈300拷贝／ml）、QL～〈10^3拷贝／ml组、103拷贝／ml～〈10^4拷贝／ml组和≥10^4拷贝／ml组，比较各组治疗48周时HBVDNA低于检测下限、ALT复常、HBeAg血清转换及发生病毒学反弹的比率。结果治疗48周时，血清HBV DNA自基线下降4．91log。HBV DNA低于检测下限的比例为33．3％。24周时HBV DNA水平越低，在48周HBV DNA达到PCR检测不到的水平和ALT复常的比率越高，发生病毒学反弹的比率越低。结论恩替卡韦治疗拉米夫定失效慢性乙型肝炎治疗24周时，PCR检测不到HBV DNA，提示在48周可达到较佳疗效，24周对HBV DNA的抑制程度可作为48周疗效的预测指标。Objective To investigate the relationship between the degree of week 24 HBV suppression and week 48 therapeutic response in entecavir-treated chronic hepatitis B patients in whom lamivudine treatment failed, so as to explore a useful predictor for efficacy of entieavir treatment. Methods Tirty-three patients with chronic hepatitis B refractory to lamivudine were enrolled to receive treatment with entecavir 1.0 mg once daily. The patients were divided into 4 groups according to serum HBV DNA levels （copies/ml） at week 24： PCR- undetectable （ 〈 300 copies/ml） ; QL- 〈 3 log10 copies/ml; 3 log10- 〈 4 log10 copies/ml; ≥4 log10 copies/ml, and the efficacy achieved at week 48 was evaluated. Results At week 48, mean reductions of serum HBV DNA from baseline was 4.91 log10. HBV DNA became undetectable by PCR assay in 33.3% patients and ALT became normal in 75.8%. The lower the HBV DNA level achieved at week 24, the higher the proportion of patients in whom HBV DNA became undetectable by PCR and ALT normalization were acquired at week 48, and viral breakthrough at week 48 also decreased. Conclusion Undetectable HBV DNA by PCR at week 24 in entecavirtreated chronic hepatitis B patients who were refractory to lamivudine, suggests a better efficacy at week 48. The degree of week 24 suppression of HBV may be used as a predictor of long term outcome.

关 键 词：肝炎 乙型 慢性 核苷酸类 拉米夫定 恩替卡韦 

分 类 号：R686[医药卫生—骨科学]