泛昔洛韦加拉米夫定联合治疗的HBV清除动力学比较  

Dynamic changes of hepatitis B virus during treatment with lamivudine versus lamivudine plus famciclovir

作　　者：侯金林[1] 冯筱榕[1] 聂忠 陈金军[1] 章廉[1] 骆抗先[1] 廖家杰[2] 

机构地区：[1]第一军医大学南方医院,广州510515 [2]中国香港大学玛丽医学院

出　　处：《中华肝脏病杂志》2000年第2期81-83,共3页Chinese Journal of Hepatology

基　　金：国家自然科学基金;全军医药卫生基金重点

摘　　要：目的比较单用拉米夫定和泛普洛韦加拉米夫定联合治疗对ＨＢＶ清除动力学的影响。方法２１例ＨＢｅＡｅ阳性慢性乙型肝炎分二组分别接受核苷类似物治疗， ９例单用拉米夫定 １５０ ｍｇ，每日一次，共 １２周； １２例泛普洛韦加拉米夫定联合治疗，其中拉米夫定 １５０ ｍｇ，每日一次，泛昔洛韦 ５００ ｍｇ，每日三次，共 １２周。每一病例均有治疗前中后系列血清标本检测ＨＢＶ ＤＮＡ。按照蒋氏数学模型分析二种治疗方案对ＨＢＶ动力学的影响。结果发现两组病例均无明显副反应。两组病例病毒负荷均呈双相衰减规律：平均下降对数值在拉米夫定治疗组为１．８±０．２，在联合治疗组为２．５± ０．８；平均抗病毒效率拉米夫定组明显低于联合治疗组（０．９４ ±０．０３对０．９８８ ±０．０１２）；１期平均下降对数值联合治疗组为１．９，而拉米夫定组仅１．１。两组病例血清病毒清除半衰期和感染病毒肝细胞清除半衰期无差异。结论泛昔洛韦加拉米夫定联合治疗慢性乙型肝炎病人的抗病毒效果优于单用拉米夫定。蒋氏数学模型可用于分析比较联合和单用抗ＨＢＶ药物的抗病毒效率。Objective To study whether combination therapy with lamivudine(LAM) and famciclovir(FCV) is effective for treatment of Chinese chronic HBV infection. Methods Chronic hepatitis B-infected patients treated with ei- ther LAM(n=9, 150 mg daily for 12 weeks) or LAM plus FCV(n=12, 150mg LAM daily plus 500mg FCV daily for 12 weeks). Serial serum HBV DNA were determined. A mathematical model was applied to analyze the dynamics of viral clearance. Results HBV clearance from patients treated with LAM was biphasic attenuation with mean antiviral efficacy of 0.94 while a combination therapy with LAM and FCV displayed an increased mean antiviral efficacy of 0.988. There was an increased magnitude of the first phase of clearance from 1.1 logic to 1.9 log10 Mean logic HBV viral decline were 1 .8± 0.2 for LAM treated group and 2.5 ± 0.8 for combination group. Conclusion Combination therapy of LAM and FCV has higher efficacy than LAM alone in suppressing HBV replication in Chinese chronic HBeAg--positive carriers.

关 键 词：拉米夫定 泛昔洛韦 乙型肝炎 HBV 

分 类 号：R96[医药卫生—药理学]