拉米夫定治疗慢性乙型肝炎早期血清丙氨酸氨基转移酶升高的临床意义  

The clinical significance of an early elevation in alanine aminotransferase level during lamivudine therapy for chronic hepatitis B

作　　者：王燕军[1] 徐旭雯[1] 梁敏锋[1] 刘瑾[2] 钟春秀[1] 万铁林[1] 陈金军[1] 丁彦青[2] 

机构地区：[1]南方医科大学南方医院感染内科,广州市510515 [2]南方医科大学基础医学院病理系,广州市510515

出　　处：《实用医学杂志》2009年第11期1857-1859,共3页The Journal of Practical Medicine

基　　金：国家自然科学基金资助项目(编号30670967);南方医科大学南方医院院长基金资助项目(编号:20070009)

摘　　要：目的:了解拉米夫定治疗早期血清丙氨酸氨基转移酶(ALT)的变化特点及其临床意义。方法:符合条件接受拉米夫定治疗的慢性乙型肝炎患者进入研究,早期ALT升高定义为治疗前4周HBV DNA下降而ALT较基线升高。结果:所有158例患者在治疗第4周HBV DNA均较基线下降,31.6%(50/158)患者ALT水平较基线升高。与ALT持续下降组比较,早期ALT升高组患者累积ALT正常化比例低(96.3%vs86.0%,P=0.035),ALT首次正常发生时间晚(治疗后平均14周vs23周,P<0.001);HBeAg阳性患者的HBeAg转阴率较低(23/89vs5/46,P=0.023),但转阴发生时间差别不明显(P=0.097);发生HBV临床耐药的比例差异无统计学意义(17.6%vs32.0%,P=0.063)。基线HBVDNA负荷高和ALT水平低是发生治疗早期ALT升高的危险因素。结论:拉米夫定治疗早期ALT升高是常见临床现象,总的来讲不是良性临床事件。Objective To explore the early change of alanine aminotransferase （ALT） during lamivudine therapy and its clinical significance. Methods The patients with chronic hepatitis B who were candidates to receive lamivudine therapy were enrolled in this study. Early ALT elevation （EAE） was defined as ALT level at week 4 higher than the baseline with a reduced HBV DNA viral load （vDNA）. Results On week 4, HBV vDNA was decreased in all the patients while ALT was elevated in 50 patients （31.6%）. As compared with those with a continuous decline in ALT, the patients with EAE had a lower cumulative ratio of ALT normalization （86.0% vs 96.3%, P = 0.035）, late initial ALT normalization after treatment （23 weeks vs 14 weeks, P 〈 0.001）, and a lower accumulative ratio of HBeAg loss （23/89 vs 5/46, P = 0.023）. However, the time to HBeAg loss and the cumulative occurrence of clinical lamivudine resistance did not differ significantly （P = 0.097; 17.6% vs 32.0%, P = 0.063）. A higher HBV vDNA and lower ALT level at baseline were risk factors for EAE. Conclusion Early ALT elevation is common during lamivudine therapy, which seems not to be a positive event.

关 键 词：肝炎 乙型 慢性 谷丙转氨酶 拉米夫定 临床耐药 

分 类 号：R512.62[医药卫生—内科学]