拉米夫定治疗慢性乙型肝炎停药后肝炎复发的临床观察

Clinical observation on the relapse of lamivudine withdrawal chronic hepatitis B

目的 探讨拉米夫定治疗慢性乙型肝炎 ,停药前加用干扰素、氧化苦参素等药物对于长期疗效的影响。方法 慢性乙型肝炎患者 48例 ,随机分为A组 (单用拉米夫定组 ) 2 6例 ,B组 (拉米夫定联合、序贯组 ) 2 2例 ,观察停药后肝功能 ,HBeAg及HBVDNA的变化情况。结果 A组在停用拉米夫定后出现肝炎的复发率为 80 .77% ( 2 1/2 6) ,ALT反跳率为 95 .45 % ( 2 1/2 2 ) ,AST反跳率为 90 .91% ( 2 0 /2 2 ) ,HBeAg复阳率 75 % ( 6/8) ,HBVDNA复阳率 72 .2 2 % ( 13 /18) ;B组停拉米夫定后肝炎复发率为 5 4.5 4% ( 12 /2 2 ) ,ALT反跳率为 60 % ( 12 /2 0 ) ,AST反跳率为 5 0 % ( 10 /2 0 ) ,HBeAg复阳率 5 0 %( 4 /8) ,HBVDNA复阳率 5 6.2 5 % ( 9/16)。A、B两组比较 ,复发率 ,ALT反跳率及AST反跳率 ,有非常显著差异 (P值分别为 0 .0 5 0 ,0 .0 0 7,0 .0 0 4)。HBeAg复阳率和HBVDNA复阳率 ,无显著差异 (P值分别为 0 .2 98,0 .2 7)。结论 拉米夫定治疗慢性乙型肝炎获得应答的患者 ,在开始时或停药前加用其他抗HBV药或免疫调节剂 ,在停用拉米夫定后 ,对减少肝炎复发率 ,ALT及AST反跳率等方面 。

ObjectiveTo observe the long-term effect of the patients with chronic hepatitis B treated with lamivudine(LAM) or LAM plus interferon-α、oxymatrine or others.Methods48 patients with chronic hepatitis B were classified to two groups. Group A of 26 patients treated with LAM and group B of 22 with LAM combination and interferon-α or matrine.The liver function and HBeAg and HBV DNA after treatment were tested.ResultsThe total relapse rate of LAM withdrawal hepatitis 、relapse rates of ALT、AST、HBeAg and HBV DNA were 80.77%(21/26) 、95.45%(21/22)、90.91%(20/22)、75%(6/8) and 72.22%(13/18) respectively in group A, while 54.54%(12/22) 、60%(12/20)、50%(10/20)、50%(4/8) and 56.25%(9/16) respectively in group B.The difference of total relapse rate、 relapse rates of ALT and AST between two groups was statistically significant (P<0.05,0.01,0.01, respectively), but the difference of the relapse rates of HBeAg and HBVDNA was not statistically significant (P>0.05).ConclusionLAM combination therapy might reduce the relapse rate after withdrawal of LAM treatment in patients with chronic hepatitis B.