拉米夫定阻断慢性乙型肝炎进展的临床对照研究

Lamivudine administration prevents fulminant hepatic failure in patients with severe chronic hepatitis B

目的应用拉米夫定治疗慢性乙型肝炎重度患者,探讨对重型肝炎发生的阻断作用。方法将164例慢性乙型肝炎重度患者随机分为常规治疗组(对照组,82例)和在常规治疗基础上加用拉米夫定治疗组(治疗组,82例)。结果在治疗组中,23．2％(19／82)的患者发展至慢性重型肝炎,显著低于对照组46．3％(3 8／82),P<0．01。对照组52．6％(20／38)的慢性重型肝炎患者死亡,而在治疗组,仅26．3％ (5／19)的患者死亡,P<0．11。两组患者肝性脑病、感染、出血、肾病等并发症发生率差异有统计学意义,P <0．05。治疗组患者肝功能、肝纤维化指标及乙型肝炎e抗原阴转率、乙型肝炎e抗原／抗-HBe转换率明显优于对照组,乙型肝炎病毒DNA持续保持阴性水平。结论在基础治疗的支持下,及时应用拉米夫定能阻断部分慢性乙型肝炎重度患者发展至重型肝炎。

Objective To study the effect of using lamivudine to prevent fulminant hepatic failure （FHF） in patients with chronic hepatitis B. Methods 164 patients were randomly put into a conventional supporting treatment control group and a lamivudine treatment group. In the latter, 82 patients were given lamivudine orally at a dose of 100 mg every day besides the support care which was also given to the control group. Results The rate of deterioration to chronic severe hepatitis in the lamivudine treatment group was significantly lower than that of the control group （23.2% vs 46.3%, P 〈 0.01）. 52.6% （20/38） with chronic severe hepatitis in the control group died. Only 26.3% （5/19） in the lamivudine treatment group succumbed to terminal liver disease （P 〈 0.01）. There was a significant difference＇between the two groups in regards to the complication incidence of gastrointestinal bleeding, infections, hepatic coma, and kidney failure （P 〈 0.05）. In addition, the recovery of liver function and liver fibrosis, and the rates of HBeAg loss and seroconversion in the lamivudine treatment group were better than those in the control group. Furthermore, the serum HBV DNA levels decreased more rapidly and continued to be substantially suppressed in the lamivudine treatment group. Conclusions Our results suggest that lamivudine administration with improved support care not only is likely to prevent chronic severe hepatitis occurrence in patients with chronic viral hepatitis B of a severe degree, but also shows some efficacy in preventing FHF.