拉米夫定治疗后HBV-DNA反弹的Logistic回归分析

MULTIPLE FACTORS ANALYSIS BY LOGISTIC REGRESSION FOR HBV-DNA RECURRENCE IN THE PATIENTS WITH CHRONIC HEPATITIS B AFTER LAMIVUDINE TREATMENT

目的:探讨拉米夫定治疗乙型病毒性肝炎有效后HBV-DNA反弹的相关因素。方法:研究对象为肝功能反复异常半年以上并伴HBV-DNA阳性(1×104copies/mL)的慢性乙型肝炎患者并接受拉米夫定治疗(100mg/d)至少1年以上;应用回顾性追踪方法,检测病人治疗前、治疗后每个月,HBV-DNA阴转后每3个月的HBV-DNA、HBsAg、HBsAb、HBeAg、HBeAb、HBcAb(两对半)、肝功能、病人停药半年内每个月、半年后每3个月的HBV-DNA、两对半、肝功能。对变量:病人的性别、年龄、用药前的谷丙转氨酶(ALT)、谷草转氨酶(AST)、HBV-DNA水平、HBeAg、是否规则用药、用药疗程等进行Logistic单因素及多因素分析。结果:曾出现HBV-DNA阴转(<1×103copies/mL)的入选病人54例,HBV-DNA反弹有30例,疗程(19.73±5.39)个月,HBV-DNA持续阴性者20例,疗程(26.38±9.90)个月(P=0.003);单因素Logistic回归分析显示用药前的ALT、HBV-DNA水平、规则用药和用药疗程与HBV-DNA反弹有关,多因素Logistic回归分析结果表明:规则用药和用药疗程与HBV-DNA反弹呈负相关。结论:规则用药和用药疗程与HBV-DNA反弹呈负相关,病人的性别、年龄、用药前ALT、AST、HBeAg、HBV-DNA水平、临床类型与HBV-DNA反弹无明显相关。

Objective：To probe into the influential factors of HBV-DNA recurrence after lamivudine therapy. Methods： The patients were selected whose liver function were abnormal with HBV-DNA positive for more than 6 months; the patients were treated with lamivudine （100 mg daily） for more then 12 months, with retrospect and tracing, the serums were collected to detect liver function, HBV-DNA and HBsAg, HBsAb, HBeAg, HBeAb, HBcAb in every month after therapy with lamivudine, and the serums every three months after HBV-DNA changed from positive to negative with lamivudine were collected also. The serum levels of liver function, HBV-DNA and HBsAg, HBsAb, HBeAg, HBeAb, HBcAb were measured every month within six months after discontinuation with lamivudine, and these targets were measured every six months after six-month＇s discontinuation with lamivudine. The factors included the sex, age, baseline levels of alanine aminotransferase （ALT）, glutamic oxalacetic transaminase （AST）, HBV-DNA, HBeAg, regular regimen , therapy course. Result：Out of 54 patients with HBV-DNA transferring negative during therapy, 30 patients had HBV-DNA recurrence with therapy course （19.73±5.39） months, 24 patients sustained HBV-DNA negative with therapy course （26.38±9.90） months （ P =0.003） ; Logistic re- gression analysis showed that high risks for HBV-DNA recurrence were independently associated with irregular regimen, short course of treatment, however the patient＇s age, sex, baseline levels of ALT, AST, HBV-DNA, HBeAg are not related with the HBV-DNA recurrence. Conclusion： High risks for HBV-DNA recurrence were independently associated with irregular regimen, short course of treatment, however the patients＇ age, sex, baseline levels of ALT, AST,HBV-DNA, HBeAg are not related with the HBV-DNA recurrence.