拉米夫定与胸腺肽序贯联合治疗慢性重型乙型肝炎的疗效分析  

Sequential combination therapy of chronic severe hepatitis B with thymus peptide and lamivudine

作　　者：高洪波[1] 许敏[1] 施海燕[1] 李粤平[1] 肖蕾[1] 

机构地区：[1]广州市第八人民医院重症肝病区,广东广州510060

出　　处：《中国病毒病杂志》2011年第6期439-442,共4页Chinese Journal of Viral Diseases

基　　金：2008年广州市医药卫生科技重点项目(2008-ZDi-11);2008年广州市医药卫生科技项目(2008-YB-080)

摘　　要：目的探讨拉米夫定与胸腺肽序贯联合治疗HBV DNA阳性慢性重型乙型肝炎和单独使用拉米夫定的疗效差异。方法将入院时HBV DNA阳性的慢性重型乙型肝炎患者随机分为治疗组61例和对照组61例,治疗组先给予拉米夫定4周,然后联合使用胸腺肽至12周,对照组仅给予拉米夫定治疗,比较两组患者12周生存率的差异,同时比较两组治疗12周时总胆红素(TB)、国际标准化比值(INR)、终末期肝病模型(MELD)、HBV DNA转阴率及T淋巴细胞亚群变化的差异,以及两组12周内合并感染的差异。结果 (1)治疗组12周生存率为77.05%(47/61),对照组为68.85%(42/61),两组比较差异无统计学意义(χ2=0.83,P=0.36)。(2)12周时治疗组TB、INR、MELD、CD4+/CD8+分别为(71.31±55.84)μmol/L、1.23±0.19、11.72±4.29、1.85±0.63,对照组分别为(148.58±159.25)μmol/L、1.45±0.73、15.53±7.49、1.56±0.59。两组比较差异均有统计学意义(P<0.05)。(3)12周时治疗组HBV DNA转阴率为85.11%(40/47),对照组为73.81%(31/42),两组比较差异无统计学意义。(4)12周内治疗组及对照组总感染病例数分别为26例(42.62%)及42例(68.85%),两组发生自发性腹膜炎分别为15例(24.59%)及28例(45.90%),两组在总感染病例数及自发性腹膜炎方面比较差异有统计学意义(P<0.05)。结论序贯联合治疗在改善慢性重型乙型肝炎患者的TB、INR、MELD分值及减少感染方面优于单独使用拉米夫定治疗。Objective To compare the treatment efficiencies of the sequential combination therapy of lamivudine and thymosin with lamivudine alone in HBV DNA positive hepatitis B patients.Methods A total of 122 severe cases of HBV DNA positive chronic hepatitis B patients were randomly divided into the treatment groups of combination therapy（61） and lamivudine alone（61） at admission.The group of combination treatment received lamivudine for 4 weeks,and then combined with thymosin to 12 weeks.The patients in lamivudine alone group were given lamivudine therapy only.We analyzed the differences of 12-week survival rates,the levels of total bilirubin（TB）,international normalized ratios（INR）,the scores of model for end-stage liver disease（MELD）,HBV DNA negative conversion rates,T lymphocyte subsets and bacterial infection rates between the two groups.Results The rates of 12-week survival were 77.05%（47/61） in the combination treatment group and 68.85%（42/61） in the lamivudine alone group.There was no significant difference between the two groups.There were significant differences in the levels of TB[（71.31±55.84）μmol/L vs（148.58±159.25）μmol/L],INR（1.23±0.19 vs 1.45±0.73）,MELD scores（11.72±4.29 vs 15.53±7.49） and the ratios of CD4＋/CD8＋ cells（1.85±0.63 vs 1.56±0.59） between the two groups（P〈0.05）,respectively.The negative conversion rates of HBV DNA were 85.11%（40/47） in the combination treatment group and 73.81%（31/42） in the lamivudine alone group at 12 weeks.The incidence rates of bacterial infections and spontaneous bacterial infections in the combination treatment group were lower（42.62% and 24.59%） than that in the lamivudine alone group（68.85% and 45.90%）（P〈0.05）,respectively.Conclusions The sequential combination therapy of lamivudine and thymosin provides better efficacy than lamivudine alone in the severe cases of hepatitis B patients.

关 键 词：重型肝炎 拉米夫定 胸腺肽 序贯联合治疗 

分 类 号：R512.62[医药卫生—内科学]