拉米夫定治疗慢性乙型肝炎失败的相关因素分析

Correlations factors involved in therapeutic failure of lamivudine for chronic hepatitis B patients.

目的探讨拉米夫定治疗慢性乙型肝炎(CHB)失败的相关因素。方法回顾性分析224例拉米夫定治疗CHB患者的临床资料,根据其疗效分为失败组和成功组,比较两组年龄、性别、用药前ALT、HBV DNA水平、治疗24周后HBV DNA阴转、规则用药、HBeAg性质及HBV YMDD变异等因素。结果拉米夫定治疗失败96例,成功128例;与成功组比较,失败组治疗前ALT水平、治疗24周后HBV DNA阴转率、HBeAg阳性患者治疗中阴转和血清转换率低(P<0.01),治疗前HBV DNA水平和HBV YMDD变异率高,患者不规则用药(P<0.01),两组在年龄和性别间的差异无显著性意义(P>0.05)。结论ALT、HBV DNA基线水平,治疗24周后HBV DNA阴转、用药规则,HBV YMDD变异及治疗后HBeAg性质改变均是影响拉米夫定治疗CHB疗效的相关因素。

Objective To investigate the correlation factors associated with therapeutic failure in chronic hepatitis B （CHB） patients who were treated with lamivudine. Methods Clinical data of 224 CHB patients treated with lamivudine were analyzed retrospectively, cases were divided into failure group and success group according to their therapeutic efficacy, the age, sex, pretreatment levels of ALT and HBV DNA, HBV DNA negative after 24 weeks treatment, Rule medication, HBeAg and HBV YMDD variations of the two groups were compared. Results There were 96 failure cases and 128 success cases who were treated with lamivudine. Compared with success group, pre - treatment levels of ALT, HBV DNA negative rate after 24 weeks treatment, negative rate and Serological conversion rate of HBcAg -positive patients in treatment were lower （P 〈0. 01 ）, pretreatment levels of HBV DNA, HBV YMDD mutation rate and irregulardrug use were higher in failure group （ P 〈 0. 01 ）. There were no different in age and sex between the two groups （ P 〉 O. 05 ）. Conclusion Baseline level of ALT and HBV DNA, HBV DNA negative after 24 weeks treatment, Rule medication, HBV YMDD variations and HBeAg change after the treatment can influence the therapeutic efficacy of lamivudine for patients with CHB.