不同方案治疗YMDD变异慢性乙型肝炎的疗效比较

Clinical study on different therapies for chronic hepatitis B patients with HBV YMDD mutations

目的:比较慢性乙型肝炎患者出现YMDD变异后不同治疗方法的疗效。方法:选择采用拉米夫定治疗后出现YMDD变异的慢性乙肝患者96例,分为A组36例,继续采用拉米夫定治疗,疗程52周;B组32例,改用α-干扰素治疗,疗程26周;C组28例,改用阿德福韦治疗,疗程52周。结果:B组和C组HBVDNA转阴率分别是43.8%和64.3%,丙氨酸转移酶(ALT)复常率分别为62.5%和71.4%,与A组相比,差异有显著性(P<0.05)。结论:慢性乙型肝炎发生YMDD变异后,继续使用拉米夫定治疗效果不理想。对于YMDD变异的患者,改用阿德福韦或α-干扰素治疗后,疗效比拉米夫定好。

Objective To explore the efficacy of different treatments for chronic hepatitis B （CHB） patients with HBV YMDD mutations. Methods 96 patients with CHB who developed YMDD mutations after being treated with lamivudine were assigned to receive consecutive lamivudine therapy for 52 weeks （36 patients,Group A）,ahernative interferon-alpha for 26 weeks （32 patients, Group B ）, or alternative adeforvir dipivoxil for 52 weeks （28 patients, Group C）. Results At the end of therapy, the negative conversion rate of HBV-DNA was 43.8% in Group B and 64.3% in Group C while the rate of ALT normalization was 62.5% and 71.4% respectively, revealing significant differences as compared with those in Group A （P〈0.05 for all comparisons）. Conelnsions The therapeutic effectiveness of lamivudine is not ideal for patients with CHB who have previous lamivudine therapy and develop HBV YMDD mutations. Adeforvir dipivoxil or interferon-alpha therapy, however, achieves a better efficacy in those patients.