拉米夫定与乙肝疫苗联合治疗儿童慢性乙型肝炎的疗效

A Study of Lamivudine and HB Vaccinum combined Treatment of Children with Chronic Hepatitis B

【目的】探讨拉米夫定与乙肝疫苗联合治疗儿童慢性乙型肝炎患者的疗效。【方法】78例患者随机分为三组:A组(拉米夫定组)20例,给予拉米夫定,共48周;B组(拉米夫定+乙肝疫苗组)20例,给予拉米夫定48周后(剂量、用法同A组),每个月皮下注射乙肝疫苗30μg一次,共4次;C组(一般治疗组)38例,仅作一般护肝治疗,疗程同上。治疗前进行血常规、肝功能、肾功能、HBV-M(ELISA法)、HBV DNA(斑点杂交法)检测。治疗3、6、12、16、18月进行上述指标检测及副作用观察。均随访至治疗开始后18个月。【结果】拉米夫定和拉米夫定+乙肝疫苗联合组患者HBV DNA普遍转阴,与C组比较有显著差异(P<0.01);联合组HBeAg阴转率和HBeAb阳转率明显提高。【结论】拉米夫定能显著抑制儿童慢性乙肝感染患者体内的HBV DNA,联合乙肝疫苗可诱导HBeAg/HbeAb血清转换。

[Objective]To study the effect of lamivudine and HB vaccinum combined treatment of children with chronic hepatitis B. [Methods]Seventy eight patients with chronic hepatitis B were randomly divided into 3 groups： lamivudine treatment group（ n = 20）, patients were treated with lamivudine for 48 weeks;lamivudine and HB vaccinum combined treatment group（ n =20）, patients were treated with HB vaccinum 30 μg by hypodermic injection once per month for 4 months following the end of lamivudine treatment; control group（ n=38）, patients were treated with conventional therapy. Blood routine, liver function, renal function , HBV serology and HBV DNA were detected before treatment and in the 3rd, 6th, 12th, 16th, 18th month after the in itiation of therapy. All cases were followed up for 18 months. [Results]Significantly higher percentage of pa tients in lamivudine group and lamivudine and HB vaccnium combined group had achieved HBV DNA negative by the end of the study than in control group（ P〈0. 005）. The serology conversion of HBeAg/HBeAb in lamivudine HB vaccinum combined group was significantly higher than that in other groups. [Conclusion] Lamivudine can actively suppress HBV reproduction in children with chronic hepatitis B, administration of lamivudine combined with HB vaccinum can induce serology conversion of HBeAg/HBeAb.