拉米夫定治疗HBeAg阳性慢性乙型肝炎的疗效预测分析

The dgree of HBV suppression with 24 week lamivudine-treatment in HBeAg-positive chronic hepatitis B patients predicts the efficacy of the treatment at week 52

目的分析拉米夫定治疗HBeAg阳性慢性乙型肝炎52周疗效与24周抑制HBVDNA程度的相关性，探讨临床疗效预测指标。方法回顾性分析拉米夫定治疗HBeAg阳性慢性乙型肝炎患者96例，根据治疗24周时HBVDNA是否阴转（HBVDNA〈10^3拷贝／ml）分为病毒学转阴组和未转阴组，比较两组治疗52周时HBVDNA、HBeAg、ALT和YMDD病毒变异。结果治疗52周时，转阴组和未转阴组HBVDNA、HBeAg转阴率、ALT复常率和YMDD变异率分别为87．7％、59．6％、93．0％、3．5％和48．7％、30．8％、2．6％、74．4％、28．2％，有统计学意义（P〈0．01）。结论拉米夫定治疗24周时，若HBVDNA〈10^3拷贝／ml，52周可获得较好疗效；若HBVDNA〉10^3拷贝／ml，则52周时疗效不佳且发生耐药的可能性增加。24周拉米夫定对HBVDNA的抑制程度可作为1年疗效的预测指标。

Objective To investigate the possibilities of an association between the degrees of HBV suppression with lamivudine-treatment at week 24 and week 52 in HBeAg-positive chronic hepatitis B patients and to find a useful predictor for treatment efficacy. Methods 96 patients with HBeAg-positive chronic hepatitis B were treated with lamivudine 100 mg per day for 52 week. They were categoized into2 groups according to their serum HBVDNA levels（copies/ml） at week 24 ： HBVDNA seroconversion group（ 〈 10^3 copies/ml） and HBVDNA non-sercoversion group （ 〉 10^3 copies/ml）. We retrospectively analyed the treatment efficacy of two groups. Results At week 52, the rate of HBVDNA undetectable and HBeAg seroconversion and ALT normalization in HBVDNA seroconversion group were higher than that in HBVDNA non-seroconversion group, but the rate of YMDD mutation was lower. The difference was significant in two groups. Conclusion HBVDNA PCR-undetectable at week 24 in lamivudine-treated HBeAg-positive hepatitis B patients suggests a better efficacy and lower viral resistance at week52. The dgree of supression of HBV at 24 weeks may be used as a predictor of one year outcome.