拉米夫定治疗后乙型肝炎e抗原血清转换患者的长期随访

A long-term observation and follow-up for patients with HBeAg/Anti-HBe seroconversion after lamivudine treatment

目的观察拉米夫定治疗发生乙型肝炎e抗原(HBeAg)／抗-HBe血清转换的慢性乙型肝炎患者的转归。方法对发生HBeAg／抗-HBe血清转换时间≥6个月、拉米夫定治疗疗程≥18个月的68例患者进行24个月以上的随访观察。结果拉米夫定治疗后HBeAg／抗HBe血清转换率为25.19％,YMDD变异率为20.59％,HBeAg／抗-HBe血清转换后随访期内复发率为27.94％,停药后复发者再服拉米夫定有效。复发与年龄、治疗前丙氨酸氨基转移酶水平有关,与治疗前HBVDNA水平、疗程及有无YMDD变异无关。结论拉米夫定治疗慢性乙型肝炎即使HBeAg／抗-HBe血清转换≥6个月仍有较高的复发率,对长期接受拉米夫定治疗的患者应加强随访观察。

Objective To observe the resulting change in patients who achieved HBeAg/Anti-HBe seroconversion after lamivudine treatment. Methods 68 patients were observed for over 24 months. They were HBeAg/Anti-HBe with a seroconversion time ≥6 months and the course of lamivudine treatment was ≥18 months. Results After lamivudine treatment, the rate of HBeAg/Anti-HBe seroconversion was 25.19%, the rate of YMDD mutations was 20.59%, and the rate of relapse was 27.94% for these patients that achieved HBeAg/Anti-HBe seroconversion in observation and in the follow-up period. Lamivudine was still an effective drug for these patients with relapses. The rate of relapse was in correlation to the patients' age and the ALT level before treatment. The rate of relapse was not correlated to the HBV DNA level before the course of treatment. YMDD mutations were not correlated to the relapses. Conclusion Even with a HBeAg/Anti-HBe seroconversion time ≥6 months, the rate of relapse was still higher in patients with chronic hepatitis B that received lamivudine. The patients with long-term lamivudine treatment should be observed and have frequent follow-up visits.