乙肝表面抗原滴度动态变化对慢乙肝患者拉米夫定耐药后加用阿德福韦酯挽救治疗效果的预测价值研究  

Predictive value of HBs Ag titer dynamic changes in rescue treatment with combination of adefovir dipivoxil and lamivudine for lamivudine-resistant CHB patients

作　　者：邓兰[1] 胡章勇[2] 张伟 范凌[2] 朱宝渔 郭啟欧 任艳[1] 刘漪沦[4] 

机构地区：[1]成都医学院第一附属医院临床医学系,四川成都610500 [2]成都医学院第一附属医院感染科,四川成都610500 [3]成都市公共卫生临床医疗中心,四川成都610000 [4]成都医学院第一附属医院科研部,四川成都610500

出　　处：《实用医院临床杂志》2017年第5期110-113,共4页Practical Journal of Clinical Medicine

基　　金：四川省卫生厅课题科研资助项目(编号:130385);四川省大学生创新创业训练计划资助项目(编号:201513705079)

摘　　要：目的探讨拉米夫定耐药后e抗原(HBeAg)阳性慢乙肝(CHB)患者血清表面抗原(HBsAg)滴度的动态变化对拉米夫定联用阿德福韦酯挽救治疗疗效的预测价值。方法收集51例拉米夫定耐药的HBeAg阳性CHB患者联用阿德福韦酯挽救治疗前后的血清,检测并分析不同应答组各时间点丙氨酸氨基转移酶(ALT)、HBsAg滴度、乙肝病毒(HBV)DNA载量差异。结果从基线到治疗12周开始,发生病毒学应答VR(+)组患者HBsAg滴度较无应答VR(-)组患者下降更快(P=0.041)。治疗12周时HBsAg滴度预测病毒学应答的ROC曲线下面积最大(AUC=0.821,P=0.006)。ROC曲线提示HBsAg为3.50 lg IU/ml时对应的Youden指数(0.612)最大。结论拉米夫定耐药后加用阿德福韦酯挽救治疗12周时HBsAg≤3.50 lg IU/ml可作为预测治疗72周发生病毒学应答的指标。Objective To investigate the predictive value of dynamic changes of quantitative hepatitis B surface antigen （ HB- sAg） concentrations in rescue treatment with combination of adefovir dipivoxil and lamivudinc for lamivudine-resistant HBsAg positive CHB patients. Methods Serum samples from 51 lamivudine-resistant CHB patients with HBsAg positive and rescue treatment of com- bination of adefovir dipivoxil and lamivudine were collected before and after various time of the treatment. Serum ALT, HBsAg and HBV DNA in these serum samples were detected and analyzed. Results The virologic response （VR） occurred in 41 of the 51 pa- tients （80. 39% ） and rest 10 patients had no VR occurred. From the baseline to the first 12 weeks of the rescue treatment, the decline of HBsAg concentrations in the VR （＋） group was faster than VR（-） group （P = 0. 041 ）. The area under the receiver operating char- acteristic curve （ROC） of predicting VR （＋） with HBsAg concentrations was the biggest at the 12 th week of treatment （AUC = 0. 821 ）. The cut-off value at 3.50 lg IU/ml had a PPV of 88.7% and a NPV of 76. 8%, respectively. Conclusion After 12 weeks of the rescue treatment, HBsAg ≤ 3.50 lg IU/ml can be used as a predictor of virologic response of these patients during the 72 weeks follow-up.

关 键 词：慢性乙型肝炎 HBSAG 拉米夫定耐药 阿德福韦酯 挽救治疗 

分 类 号：R512.6[医药卫生—内科学]