拉米夫定治疗慢性乙型肝炎患者3年疗效观察

Clinical observation of lamivudine in patients with chronic hepatitis B for three years

目的初步探讨LAM长期治疗HBeAg阳性和HBeAg阴性的两组慢性乙型肝炎(CHB)患者生化学、病毒学指标的变化及临床转归的差异。方法对63例诊断为CHB的患者均给予拉米夫定100mg,每日一次,进行3年的随访观察,动态检测患者的HBV血清标志物,HBV DNA,ALT、AFP、YMDD变异、B超等指标。结果拉米夫定治疗HBeAg阳性和HBeAg阴性的CHB患者3年时,HBeAg阳性组ALT复常率、HBV DNA阴转率、肝细胞癌发生率及HBsAg阴转率分别为64.7%、64.7%、0%、0%;HBeAg阴性组ALT复常率、HBV DNA阴转率、肝细胞癌发生率及HBsAg阴转率分别为70.4%、77.8%、0%、0%。两组间ALT复常率、HBV DNA阴转率、肝细胞癌发生率及HBsAg阴转率两组差异均无统计学意义(P>0.05);HBeAg阳性组YMDD变异率(43.3%)显著高于HBeAg阴性组(18.2%),x2=4.720,P<0.05;HBeAg阴性组肝硬化患者(37.0%)显著高于HBeAg阳性组(5.9%),x2=3.866,P<0.05。结论拉米夫定治疗HBeAg阳性CHB患者较HBeAg阴性患者更容易发生YMDD变异,HBeAg阴性CHB患者较HBeAg阳性患者更易发生肝硬化。

Objective To evaluate the diversity of biochemical virological indicator and the different clinical prognosis between HBeAg-positive and HBeAg-negative chronic hepatitis B group（CHB） patients with the long term therapy of lamivudine.Methods Sixty-three patients with chronic hepatitis B were treated with lamivudine,100mg/d and observed for three years.The serum HBV markers,HBV DNA,ALT,AFP and other biochemical indicators were detected.Results In the HBeAg-positive therapy group,the ratio of ALT normalization,the ratio of HBV DNA negative conversion,the incidence rate of hepatocellular carcinoma and the ratio of HBsAg negative conversion were 64.7%,64.7%,0%,0% after three years respectively;In the HBeAg-negative therapy group,these rates were 70.4%,77.8%,0%,0% respectively.There was no significant difference between the two groups.The ratio of YMDD mutation of HBeAg-positive patients was 43.3%,which was significantly higher than that（18.2%） in HBeAg-negative,x2=4.720,P0.05.The proportion of patients with liver cirrhosis in HBeAg-negative group（37.0%） was higher than that in HBeAg-positive group（5.9%）,x2=3.866,P0.05.Conclusion The patients with HBeAgpositive is more susceptible to YMDD mutation than HBeAg-negative patients;HBeAg-negative patients is more susceptible to liver cirrhosis than HBeAg-positive patients in the treatment of lamivudine.