拉米夫定耐药的慢性乙肝患者联合干扰素或苦参素治疗疗效观察

IFN or oxymatrine in combination with lamivudine in patients with lamivudine-resistant chronic hepatitis B

目的 观察拉米夫定耐药的慢性乙型肝炎患者联合干扰素或苦参素治疗的效果。方法 4 0例患者在继续应用拉米夫定的前提下 ,A组 14例联合应用干扰素a 2b 3MUIM每日 1次 ,30d ,然后隔日 1次 ,共计 6个月。B组 15例联合苦参素 ,苦参素 6 0mg ,IM每日 1次 ,3个月 ,然后改为口服0 2g每日 3次 3个月。C组 11例继续单用拉米夫定 10 0mg每日 1次口服。疗程结束后 ,观察乙肝病毒血清学指标HBVDNA、HBeAg阴转及HBeAg anti HBe转换 ,肝功能 (ALT)恢复情况。结果 联合干扰素治疗组 ,HBVDNA阴转率为 35 71% (5 14 ) ;联合苦参素治疗组HBVDNA阴转率为 13 33% (2 15 ) ,ALT复常率分别为 85 71% (12 14 )、86 6 7% (13 15 )。C组无HBVDNA及HBeAg阴转 ,ALT复常率为 36 36 % (4 11)。结论 对拉米夫定耐药的慢性乙型肝炎患者 ,联合干扰素或苦参素治疗后 ,可以提高拉米夫定疗效 ,抑制病毒复制 ,促进肝功能恢复。

Objective To observe the therapeutic efficacy of IFN or oxymatrine in combination with lamivudine in patients with lamivudine-resistant chronic hepatitis B. Methods Forty patients ongoing treatment with lamivudine were randomized to three groups:group A,14 patients with addition of IFN α-2b 3MU to ongoing lamivudine,daily,one month,followed by the same dose given every other day,five months;group B,15 patients with addition of injectable oxymatrine 60 mg daily,three months,followed by oral oxymatrine every day,three months,and group C,11 patients ongoing treatment with lamivudine alone. The HBV DNA level in serum,HBeAg seroconversion,and ALT level were detected at the end of the treatment. Results After 6 months of treatment,HBV DNA became negative in 35.73% patients treated with combination with IFN,and in 13.3% patients treated with combination with oxymatrine. ALT level was normal in 85.71% or 86.66% of patients,respectively. In none of the patients under ongoing treatment with lamivudine alone HBV DNA or HBeAg became negative,and ALT level was normal in 36.36% of patients. Conclusion These data indicated that IFN or oxymatrine in combination with ongoing lamivudine therapy provided effective antiviral therapy in patients with lamivudine-resistant HBV. The addition of IFN or oxymatrine to ongoing lamivudine therapy in lamivudine-resistant patients led to significant inhibition of viral replication and improvement in liver function after 6 months of therapy.