拉米夫定联合乙肝疫苗治疗慢性乙型肝炎39例

Combination therapy of lamivudine and hepatitis B vaccine for chronic hepatitis B:an analysis of 39 cases

目的:评价乙肝疫苗联合抗病毒药治疗慢性乙型肝炎(CHB)的临床疗效,寻找更有效的CHB治疗方案.方法:79例CHB患者随机分成拉米夫定治疗组(A组,n=40)和拉米夫定联合乙肝疫苗治疗组(B组,n=39),A组采用拉米夫定抗病毒治疗;B组除口服拉米扶定外,自第13wk开始,加乙肝疫苗20μg皮下注射,每2wk1次,共用12次.结果:治疗52wk时,联合治疗组HbeAg+CHB患者血清ALT水平正常转化率显著高于单独拉米夫定治疗组(93.3%vs78.1%,P=0.026);治疗24wk时,联合治疗组HbeAg+病例HBV DNA转阴率明显高于单独使用拉米扶定组(93.3%vs43.8%,P<0.05),52wk时差异仍具有显著性(93.3%vs68.8%,P=0.021),但在HBeAg-病例中,两组间HBV DNA转阴率无显著性差异.两组间HbeAg+病例HbeAg血清学转化或消失、以及HbeAg-病例ALT和HBV DNA血清学转化率之间无明显差异.两组均未出现明显不良反应.结论:拉米扶定联合乙肝疫苗是治疗CHB安全有效的方案,治疗期间可以提高ALT正常转化率和HBV DNA血清学转化率,特别是对于HBeAg+患者更有意义.

AIM： To investigate the therapeutic efficacy of combination therapy of LAM plus hepatitis B （HB） vaccine for chronic HBV-infected patients.METHODS： A total of 79 chronic HBV-infected patients CHB were enrolled in the study, and randomized to receive either LAM monotherapy （n = 40） or combination therapy of LAM and HB vaccine （n = 39）. In the combination therapy group, 100 mg/d of LAM was administered as a baseline therapy, and 20 μg of HB vaccine was rejected subcutaneously every two weeks starting at the 13th week after LAM administration, 12 times in total.RESULTS： After 52 weeks＇ treatment, the rate of ALT normalization in HBeAg patients was significantly higher in combination therapy group than in the monotherapy group （93.3% vs 78.1%, P = 0.026）. After 24 weeks＇ treatment, the HBV DNA negativity rate in HBeAg~ patients was significantly higher in combination therapy group than in monotherapy group （93.3% vs 43.8%, P 〈 0.05）, and rates of HBeAg loss or HBeAg seroconversion in HBeAg＊ patients were not remarkably different between monotherapy group and combination group, as well as the rates of ALT normalization or HBV DNA se- roconversion in HBeAg patients between the monotherapy group and combination group. At the same time, no adverse effects with the use of HB vaccine were observed in all the patients treated with the combination therapy.CONCLUSION： Combination therapy of LAM and HB vaccine is a safe and effective way to enhance the rate of ALT normalization and HBV DNA negativity, especially in HBeAg＋ patients.