拉米夫定治疗HBeAg阳/阴性慢性乙型肝炎路线图研究

Route chart for management of patients receiving oral lamivudine for chronic hepatitis B

目的探讨拉米夫定（Lamivudine，LAM）治疗HBeAg阳性／阴性慢性乙型肝炎（e^＋／e^- CHB）的路线图异同，为LAM在e^＋／e^-CHB抗病毒治疗过程提供指导。方法采用随机、平行对照的研究方法，按患者就诊时间分别随机选机选取e^＋CHB和e^-CHB各52例，两组均口服LAM片100mg，口服，1次／a，连续服用52周，停药后观察12周，分别对治疗前、治疗期间第4周、12、24、36、48、52周进行HBVDNA定量检测，同时监测肝功、HBVM及其他指标。采用SSPS11．0统计软件进行，检验，P〈0．05差异有统计学意义。结果e^＋GHB／e—CHB患者治疗期间各观察时间点HBV—DNA转阴率比较，e^-CHB患者HBV—DNA转阴率在各观察时间点均高于e^＋CHB患者（除第52周P〈0．05外，其他各时间点P〈0．01），e^＋CHB患者在第52周达到高峰66．67％（32／48），而e^-CHB患者在第36周达到高峰91．67％（44／48）。结论LAM能有效抑制e^＋／e^-CHB的病毒复制，总体上e^-CHB优于e^＋CHB，但HBV—DNA转阴率的高峰时点有所不同，可能其治疗中的路线图也会有所不同。

Objective To compare the serum virological response and end - of - dose failure after treatment with lamivudine （LAM） in patients with chronic hepatitis B（CHB） infection. Methods 104 patients were divided into HBeAg（ ＋ ）CHB and HBeAg （ - ）CHB groups ,and both groups were given oral LAM 100 mg/d. The treatment lasted 52 weeks. Serum HBV DNA level of all patients were examined before and at 4, 12, 24 ,36 , 48, and 52 weeks during the treatment. Results The serum HBV DNA response rate of the HBeAg（ ＋ ） CHB group was lower than that of HBeAg（ - ） group at different times during therapy（ P 〈 0.01 ）. But the time point of HBV - DNA response rate between the two groups had significant variation（ e^＋ CHB at 52w, e^- CHB at 36w）. Conclusions LAM effectively suppresses the serum HBV DNA in patients with HBeAg（ ＋ ）and HBeAg（ - ）chronic hepatitis B infection. But the early response rate and end - of - dose failure rate of the two groups were significantly different. But the time point of HBV - DNA response rate between the two groups had significant variation. Maybe there is difference in route chart for management of patients receiving oral lamivudine for chronic hepatitis B.