拉米夫定治疗4周检测HBV DNA水平对52周疗效的预测  

Predicting the Efficacy of 52-week Lamivudine Treatment by Testing Hepatitis B Virus DNA Levels at 4-week

作　　者：杨柳絮[1] 赵中夫[2] 刘明社[2] 马丽娜[1] 王麟[1] 韩红莉[1] 卢俊敏[1] 常蕴青[1] 

机构地区：[1]山西医科大学,传染病学硕士研究生030001 [2]长治医学院肝病研究所

出　　处：《长治医学院学报》2008年第2期85-87,共3页Journal of Changzhi Medical College

基　　金：山西省自然科学基金(20011073)

摘　　要：目的:探讨拉米夫定(LVD)治疗4周检测血清HBV DNA水平对远期HBV DNA转阴率、ALT复常率和耐药发生率的预测价值。方法:入组100例YMDD阴性的慢性乙型肝炎患者(CHB),其中HBeAg阳性患者72例,HBeAg阴性患者28例。男70例,女30例。LVD100mg/d治疗4周,检测血清HBV DNA水平,将HBV DNA<103拷贝/mL患者45例和≥103拷贝/mL55例分别作为Ⅰ组和Ⅱ组继续观察。治疗52周后,检测血清HBV DNA,ALT,HBVM和YMDD。结果:血清HBV DNA转阴率:Ⅰ组为93.3%,Ⅱ组为43.6%,χ2=27.24,P<0.001;ALT复常率:Ⅰ组为95.6%,Ⅱ组为70.9%,χ2=10.186,P=0.001;YMDD变异率:Ⅰ组为0%,Ⅱ组为23.6%,χ2=12.226,P<0.001;HBeAg血清转换率:Ⅰ组为55.6%,Ⅱ组为36.3%,χ2=3.683,P=0.055。结论:拉米夫定治疗4周对HBV DNA的抑制程度可预测52周的疗效。Objective： To evaluate the efficacy of 52 - week lamivudine treatment by testing hepatitis B virus DNA levels at 4- week. Methods： 100 patients with YMDD - negative chronic hepatitis B were received LVD 100 mg/d for 4 weeks. They were then categorized into 2 groups according to their serum HBV DNA levels （copied/mL） ： HBV DNA 〈 10^3（group Ⅰ ） and HBV DNA ≥ 10^3（group Ⅱ ）, and the treatment was continued. At week 52, YMDD was tested by mismatched - PCR. HBV DNA levels were measured by quantitative PCR, alanine aminotransferase（ALT）and HBeAg were conducted according to instructions. Results： Although HBeAg seroconversion of patients occurred in group Ⅰ was similar to that in group Ⅱ （55.6% versus 36.3% P 〉 0.05）, higher proportions of patients in group Ⅰ than that in group Ⅱ achieved HBV DNA 〈 10^3 copies/mL（93.3 % versus 43.6%, P 〈 0.001）. Rate of ALT normalization of patients in group Ⅰ significantly increased than that in group Ⅱ （95.6% versus 70.9%, P = 0. 001）, and the YMDD mutation rate was remarkably declined in group Ⅰ as compared with that of the group Ⅱ through 52 weeks. Conclusion： The measurement of the HBV DNA levels at week 4 of lamivudine treatment should be performed to predict 52- week outcome and YMDD mutation rate.

关 键 词：YMDD变异 拉米夫定 阿德福韦酯 慢性乙型肝炎 

分 类 号：R512.62[医药卫生—内科学] R541.4[医药卫生—临床医学]