拉米夫定治疗慢性乙型肝炎患者的疗效观察

The observation of lamivudine's therapeutic effects to the patients with chronic hepatitis B

目的探讨拉米夫定治疗慢性乙型肝炎(CHB)患者的疗效。方法按治疗前血清 ALT 水平将 CHB 患者分为二组:A 组26例 ALT>200IU,B 组34例 ALT<200IU。C 组为30例 HBV 携带者。所有受试对象均接受拉米夫定治疗一年,并加中西药辅助治疗。采用荧光定量 PCR 法检测血清 HBVDNA 含量,采用 ELISA 法检测血清乙肝五项指标。结果治疗后 A 组血清 HBV DNA 含量2.96±0.74,显著低了 C 组(P<0.01),血清 HBV DNA 阴转率84.6%、HBeAg 阴转率 69.2%、HBeAb 转换率61.5%,均显著高于 C 组(P<0.05,P<0.01)。治疗后 B 组血清 HBV DNA 含量3.33±1.20,显著低于 C 组(P<0.05),血清HBeAg 阴转率58.8%、HBeAb 转换率50.0%,均显著高于 C 组(P<0.05)。治疗后 C 组血清 HBV DNA 含量4.22±1.81,HBV DNA 阴转率56.7%,HBeAg 阴转率33.3%,HBeAb 转换率23.3%。结论拉米夫定对CHB 患者治疗效果好,对 HBV 携带者也有一定疗效;治疗前 ALT 水平高的 CHB 患者对拉米夫定治疗更为敏感。

Objective To explore lamivudine's therapeutic effects to the patients with chronic hepati- tis B(CHB).Methods According to serum ALT level before the therapy,60 patients with CHB were divided into A group with 26 eases(ALT>200IU) and B group with 34 cases(ALT<200IU).C group included 30 HBV carriers.Above three groups were treated by lamivudine and chinese traditional as well as western drugs for one year.Serum HBV DNA level and HBV five markers in three groups were measured by quantitative PCR of fluorimetry and ELISA respectively.Results After the therapy,serum HBV DNA level in A group was 2.96±0.74,which was significantly lower than that in C group(P<0.01),while serum HBV DNA negative rate as well as HBeAg negative rate and HBeAb positive rate in A group were 84.6%,69.2% and 61.5% respec- tively,which were significantly higher than that in C group (P<0.05,P<0.01).Serum HBV DNA level in B group was 3.33±1.20,which was significantly lower than that in C group (P<0.05),while HBeAg negative rate and HBeAb positive rate in B group were 58.8% and 50.0% respectively,which were significantly higher than that in C group(P<0.05).Serum HBV DNA level in C group was 4.22±1.81,while serum HBV DNA neg- ative rate as well as HBeAg negative rate and HBeAb positive rate in C group were 56.7%,33.3% and 23.3% respectively.Conclusion Lamivudine might have good therapeutic effects to the patients with CHB,and have some therapeutic effects to the HBV carriers too.The patients with CHB who have high serum ALT level be- fore the therapy might be more sensitive to lamivudine.