拉米夫定长期治疗慢性乙型肝炎42例临床分析

The study on the efficacy of long-term continuous administration of Lamivudine(LMV) in patients with chronic hepatitis B

目的：评价拉米夫定（LMV）长期治疗慢性乙型肝炎（慢乙肝）的临床疗效. 方法：141例慢乙肝患者HBsAg（＋）、 HBeAg（＋）、 HBV-DNA≥1×10^5 copies 、ALT≥80 IU,并除外甲丙丁戊肝炎、自身免疫肝炎、各种肝硬化及各种脂肪肝.均服用LMV 100 mg/d,口服,持续5～7年.11例服用LMV 6个月后加用α干扰素600万U,隔日1次肌注,持续1年.发生YMDD变异后,加复阿德福韦酯（ADV）10 mg/d,口服.上述指标每3个月检查1次.结果：42例HBeAg转换为抗HBe,HBV-DNA转阴,ALT复常,获完全并持续应答（29.8%）,4例叠加α干扰素治疗后HBsAg消失,抗HBs转阳,获临床治愈（36.4%）.6例发生YMDD变异而反跳者经过加服ADV再次获得完全应答.结论：LMV价格合理,安全性好,口服方便,是治疗慢乙肝有效的抗病毒药物之一.

Objective： To evaluate efficacy of long term continuous administration of LMV in patients with chronic hepatitis B. Methods： One hundred and forty one patients with chronic hepatitis B （CHB） recepted thrapy of administration of LVD 100 mg/d for 5～7 years. Their serum HBsAg, HBeAg were all positive, and serum HBV-DNA≥1. 0× 10^5 copies, ALT≤80 IU. Some patients treated with LMV after 3 month added interferon α 6 M IU/qod im for one year. Some patients determined YMDD mutations changed to administration of ADV 10 mg/d for at least 1 year. Serum HBsAg, HBeAg, HBV-DNA, ALT were determined once/ per 3 month. Results： 42/141 cases with CHB recepted thrapy of administration of LVD geted complete response（29.8%）. 4 /11 cases added using interferon a geted clinic convalescence（36.4%）. 6/ 42 cases determined YMDD mutations geted complete response again. Conclusion： Therapy of long term continuous administration of LMV in the patients with CHB is effective and safe. Combination of LMV and interferon α in treatment of patients with CHB may get a better effect.