拉米夫定与α-干扰素序贯治疗慢性乙型肝炎疗效观察

Observations on sequential treatment with lamivudine and interferon-α in patients with chronic hepatitis B

目的探讨拉米夫定与α-干扰素序贯治疗慢性乙型肝炎(chronic hepatitis B,CHB)疗效。方法98例HBeAg阳性CHB患者随机分成A、B两组。A组用拉米夫定100mg.d-1口服,8周后联合α-干扰素5MIUsc,隔日1次,治疗8周,最后单用α-干扰素5MIU16周;B组单用α-干扰素5MIUsc,隔日1次,共24周;两组患者在α-干扰素停药后随访6个月。结果结束时,A组HBeAg转阴率、HBeAg转换率、ALT复常率、HBV DNA转阴率、HBV DNA<105与B组比较,P值均<0.05;但完全应答率无差异;而随访6个月时,A、B两组各指标均无差异。结论拉米夫定与α-干扰素二者序贯治疗CHB短期疗效优于单一α-干扰素治疗。

OBJECTIVE To study the efficacy of sequential treatment with lamivudine and interferon-α in patients with chronic hepatitis B. METHODS 98 patients with positive hepatitis B virus DNA and hepatitis B e antigen were randomly divided into A group（51 patients） and B group（47 paitents） ;A group were treated with lamivudine 100mg·d^- 1 alone for 8 weeks, then with both IFN-α 5MIU qod and lamivudine 100mg·d^- 1 for 8 weeks, and at last with IFN-α alone for 16 weeks. B group were treated with IFN-α 5MIU qod for 24 weeks. All patients were followed up 48 weeks at the end of the therapy. RESULTS At the end of the therapy, HBeAg negative conversion rates, HBeAg-to-anti-HBe seroconversion rates, HBVDNA negative conversion rates, recovery rates of ALT, and the rates of HBVDNA〈 10^s copies/mL in the two groups had significant differences （P 〈 0.05） ; but 6 months after the end of treatment, HBeAg negative conversion rates, HBeAg-to-anti-HBe seroconversion rates, HBVDNA negative conversion rates, recovery rates of ALT, complete response rates, and the rates of HBVDNA〈 10^5 copies/mL in the two groups had no significant differences（P 〉0.05）. CONCLUSION Sequential treatment with lamivudine and interferon-α in patients with chronic hepatitis B had better therapeutic effect than treatment with interferon-α alone, and had further evaluation in clinical trials.