拉米夫定治疗儿童慢性乙型肝炎的临床研究

A clinic study of lamivudine on the treatment of children with chronic hepatitis B

目的 观察拉米夫定治疗儿童慢性乙型肝炎的临床疗效及对乙肝病毒标志物的影响。方法 选择慢性乙型肝炎患儿 6 3例 ,随机分为拉米夫定治疗组和对照组 ,治疗组给予拉米夫定每天 3mg/kg服用 ,同时给予西利宾胺片和甘草甜素片护肝治疗 ,疗程 2年 ,追踪观察 1年。对照组仅给予西利宾胺片及甘草甜素片 ,剂量疗程与治疗组相同。观察两组患儿外周血白细胞数、血小板数、血肌酐、肝功能及乙肝病毒标志物的变化。结果 两组患儿的外周血白细胞数、血小板数及血肌酐差异无显著意义 (P >0 0 5 )。两组患儿的ALT复常率分别是 94 3%和 5 3 6 % (P <0 0 1) ;HBVDNA阴转率分别是 88 6 %和 3 6 % (P <0 0 1) ;HBeAg的阴转率分别是 5 4 3%和 3 6 % (P <0 0 1) ;抗HBe阳转率分别是 4 8 6 %和 3 6 % (P <0 0 1) ,停药 1年时 ,两组患儿的ALT复常率分别是 74 3%和 4 2 9% (P <0 0 5 ) ,HBVDNA阴转率分别是 4 5 7%和 3 6 % (P <0 0 1) ,HBeAg/抗HBe血清转换率分别是 4 5 7%和 3 6 % (P <0 0 1)。结论 拉米夫定治疗儿童慢性乙型肝炎是安全有效的药物之一。

Objective To observe the clinic effect of lamivudine in children with chronic hepatitis B and its influence of HBV markers.Methods 63 children with chronic hepatitis B were divided into two groups randomly.All the 28 cases in the control group were treated with silybin meglumine tablet and glycyrrhizic acid tablet and the 35 cases in the treatment group,with lamivudine 3mg/kg or so in addition to the treatment given in the control group.The two groups were treated for 2 years and one year following-up was performed observing changes in WBC,BPC,Cr,liver function and peripheral blood HBV markers.Results There was no significant deviation of WBC,BPC and Cr between the two groups(P>0.05).By the end of the treatment course ALT recovery rate was 94.3% for the treatment group and 53.6% for the control group(P<0.01);HBV DNA negative rate was 88.6% for the treatment group and 3.6% for the control group(P<0.01);HBeAg negative rate was 54.3% for the treatment group and 3.6% for the control group(P<0.01);anti-HBe positive rate was 48.6% for the treatment group and 3.6% for the control group(P<0.01).One year later,the ALT recovery rate was 74.3% for the treatment group and 42.9% for the control group(P<0.05);HBV DNA negative rate was 45.7% for the treatment group and 3.6% for the control group(P<0.01);HBeAg/anti-HBe transision rate was 45.7% for the treatment group and 3.6% for the control group(P<0.01).Conclusion Lamivudine is a safe and effective medicine in treating children with chronic hepatitis B.