拉米夫定治疗慢性乙型肝炎的疗效影响因素  

Factors associated with response to lamivudine： restrospective study of 233 patients with chronic hepatitis B

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

机构地区：[1]广东省惠州市中心人民医院消化内科肝病区,516001

出　　处：《中华肝脏病杂志》2009年第8期564-568,共5页Chinese Journal of Hepatology

摘　　要：目的探讨拉米夫定治疗慢性乙型肝炎患者的疗效影响因素，并初步评价基线特征、24周早期病毒学应答及治疗方案对疗效和病毒学突破（VB）发生率的影响。方法对接受拉米夫定治疗的233例慢性乙型肝炎患者（其中90例治疗期间加用或换用阿德福韦酯）的专科门诊病历资料进行回顾性分析，采用聚合酶链反应法、酶联免疫吸附法分别检测HBV DNA水平与HBsAg、抗HBs、HBeAg、抗-HBe水平。用SPSS17．0统计软件通过Kaplan—Meier法描述生存时间分布，并分析基线HBV DNA水平、HBeAg状态、ALT水平和疗效的关系。计量资料用t检验分析，计数资料用χ^2检验。结果HBeAg阳性与HBeAg阴性患者HBV DNA阴转率分别为63．4％和84．6％，ALT复常率分别为83．8％和81．3％，VB发生率分别为31．0%和14．3％；60．6％的HBeAg阳性患者出现HBeAg阴转，28．9％出现HBeAg／抗-HBe血清学转换。HBeAg阳性患者中，与基线ALT〈2．5×正常值上限（ULN）者比较，≥2．5×ULN者HBV DNA阴转率无明显变化（P〉0．05），而HBeAg阴转率（66．7％与45．0％）和HBeAg血清学转换率（33．3％与17．5％）明显升高（P值均〈0．05），VB发生率则明显下降（34．3％与50．0％，P〈0．05）；基线HBV DNA〈1×10^6拷贝／ml者VB发生率为23．4％，与HBV DNA≥1×10^6拷贝／ml者的46．3％比较，差异有统计学意义（P〈0．05）。HBeAg阳性患者24周有初始病毒学应答（IVR）者的HBV DNA阴转率（76．3％与45．5％）、HBeAg阴转率（72．4％与43．9％）和HBeAg血清学转换率（40．8％与12．1％）均明显高于无IVR者（P值均〈0．01），VB发生率较低（28．9％与45．5%，P〈0．05）。出现VB后，与单一拉米夫定组比较，加药或换药组中HBeAg阳性者HBV DNA阴转率（40．6％与16．7％）、HBeAg血清学转换率（21．9％与0）较高，HBeAg阴转率（37．5％与41．7％）较低，ALT复常率无差�Objective To identify factors associated with response to lamivudine in chronic hepatitis B patients. Methods Clinical data of 233 chronic hepatitis B patients treated with lamivudine 100 mg daily （91 patients were switched to Adefovir 10mg daily or Adefovir 10mg in combination with lamivudine 100 mg daily） were retrospected. HBV DNA level and serum HBV markers were detected by polymerase chain reaction and enzyme-linked immunosorbent assay. Kaplan-Meier, long-rank, t test were conducted to evaluate the data. Results （1） The rates of HBV DNA loss, ALT normalization, viral breakthrough（VB）, HBeAg loss and seroconversion were 63.4%, 83.8%, 30.9%, 30.9%, and 14.3%, respectively, in HBeAg（＋） patients; and these were 84.6%, 81.3%, 14.3%, respectively in HBeAg（-） patients.（2） The rates of HBV DNA loss, HBeAg loss, HBeAg seroconversion, viral breakthrough （VB） were 55% and 66.7% （P 〉 0.05）, 55.0%, and 66.7% （P 〈 0.05）, 17.5% and 33.3% （P 〈 0.05）, 50% and 34.3% （P 〈 0.05） in HBeAg（＋） patients with baseline ALT 〈 2.5 ULN and HBeAg（＋） patients with baseline ALT≥ 2.5 ULN, respectively. （3） For HBeAg（＋） patients, viral breakthrough rate was significantly lower in patients with baseline HBV DNA 〈10^6 copies/ml than that in patients with baseline HBV DNA≥ 10^6 copies/ml patients （23.4% VS 46.3%, P 〈 0.05） among HBeAg（＋） patients. （4） The rate of HBV DNA loss, HBeAg loss, HBeAg seroconversion and viral break-through for the patients with IVR at week 24 were 76.3%, 72.3%, 40.8% and 28.9% compared to 47.6% （P 〈 0.01）, 46% （P 〈 0.01）, 12.7% （P 〈 0.01） and 47.6% （P 〈 0.05） for those without IVR. （4） For the 44 patients with viral breakthrough, 32 were switched to Adefovir monotherapy or adefovir in combination with lamivudine therapy, and 12 continued to recieve lamivudine monotherapy. HBV DNA loss, HBeAg seroconversion were 40.6%, 21.9% for those switch/add group compare to 16.7%, 16.7% for the lamivudine

关 键 词：肝炎 乙型 慢性 拉米夫定 治疗结果 影响因素 

分 类 号：R512.62[医药卫生—内科学] R978.7[医药卫生—临床医学]