抗病毒治疗对慢性乙型肝炎肝组织HBV DNA及病理的影响

Efficacy of antiviral treatment on intrahepatic HBV DNA and histology in HBeAg-positive chronic hepatitis B patients

目的探讨抗病毒治疗对慢乙肝肝组织HBV DNA及病理的影响。方法75例HBeAg阳性的慢乙肝患者分别接受拉米夫定一干扰素序贯治疗24例、拉米夫定35例或干扰素a2b16例，抗病毒治疗，检测治疗前48周患者肝组织HBV DNA及炎症指数（HAI）。结果抗病毒治疗48周，三组患者血、肝组织HBV DNA及HAI均值明显下降（P〈0．05），序贯治疗组HBeAg血清转换率（38．1％）稍高于其他两组（P=0.1352）。HBeAg血清转化患者（17例）和HBVDNA阴转患者（21例）肝组织HBV DNA基线值明显低于其他患者（P〈0．05）。结论抗病毒治疗可以抑制肝组织HBV的复制，改善肝细胞的炎症坏死；肝组织HBV DNA水平低者抗病毒疗效好。序贯治疗可能获得较高的HBeAg血清转化率。

Objective To evaluate the effect of antiviral agents on intrahepatic HBV DNA and histology in HBeAg-positive chronic hepatitis B patients. Methods Thirty-five patients were treated with lamivudine, 16 with interferon alfa （INF-α）, 24 with sequential Lamivudine and INF-α. The total duration of therapy was 12 months. Intrahepatic HBV DNA was measured quantitatively by real-time polymerase chain reaction. Results There was significant change in all parameters of the groups of patients at the end of treatment （ P 〈 0.05）. The patients treated with sequential treatment had slightly higher HBeAg rate （38.1% ） than that of the other patients （ P = 0.1352）. The baseline levels of intrahepatic HBV DNA in the patients with HBeAg or undetectable serum HBV DNA were significantly lower than that of the other patients （ P 〈 0.05）. Conclusion Antiviral agents could effectively inhibit intmhepatic HBV DNA and improve hepatic histology. The patients with low baseline intrahepatic HBV DNA level may achieve better antiviral efficacy. Sequential treatment might produce high HBeAg seroconversion rate.