38例拉米夫定停药后肝炎临床分析

Clinical Characteristics and Retherapyof Lamivudine Withdrawal Hepatitis

目的研究拉米夫定停药后肝炎的临床特点与再次治疗。方法随访调查拉米夫定停药后复发的慢性乙型肝炎患者，记录用药前病程、诊断，拉米夫定用量、疗程、疗效、停药原因，观察肝功能、血清学及病毒学变化，再次治疗及预后情况。结果38例纳入临床分析。所有病人停药时肝功能正常、HBVDNA降至检测水平以下。14例自行停药，7例有院外购药史，17例遵医嘱停药；肝炎复发距停药的时间4～6个月。肝炎复发后均给以保肝、降酶综合治疗；27例再次服用拉米夫定治疗；5例改用α-干扰素治疗。自行停药者复发后病情较重，其中发生肝功能失代偿3例，肝功衰竭死亡1例。再次应用拉米夫定治疗短期疗效与初次治疗相似。结论慢性乙型肝炎应用拉米夫定治疗停药后易复发，治疗前肝功损害严重者，复发后易出现肝功能失代偿；复发后应尽早应用拉米夫定或其他核苷类药物治疗，同时应加强综合治疗。

Objective： To study the clinical characteristics and the retherapy of lamivudine withdrawal hepatitis. Methods： Patients with recurrent chronic hepatitis B after withdrawing lamivudine were followed up. The course of disease and diagnoses, the dosage of lamivudine, the course of treatment, the curative effective and causes of withdrawing drugs were recorded. The liver function, the changes of serumology and virusology, the retherapy and the prognosis were observed. Results： 38 cases were included in clinical analyses. All the patients had normal liver function when withdrawing drugs and HBVDNA dropped below baseline. 14 cases withdrew drugs by themselves, 7 cases bought drugs out of the hospital and 17 cases withdrew drugs according to the doctors＇ advice. There were 4 to 6 months between withdrawal drugs and recurrence of hepatitis. General treatment of liver protection and enzyme reduction were given after recurrence. 27 cases took lamivudine again, 5 cases changed to et - interferon. The condition of the patients who withdrew drugs by themselves became relatively serious ; 3 of them had decompensation and 1 of them died of hepatic failure. The short - term curative effect after using lamivudine again and the effect of initial treatment were similar. Conclusion： It is easy for patients with chronic hepatitis B to recur after withdrawing lamivudine. Those whose liver function was seriously damaged before treatment tend to have liver function decompensation after recurrence. Lamivudine should be taken soon after recurrence and combined treatment should be strengthened at the same time.