拉米夫定联合清肝解毒汤对肝郁脾虚型慢性乙型肝炎多聚酶基因变异的影响

Effect of Lamivudine in Combination with Qingganjiedutang on Pol Gene Mutation in Patients with Chronic Hepatitis B of Stagnation of Liver-Qi with Spleen Deficiency

目的观察拉米夫定联合清肝解毒汤治疗肝郁脾虚型慢性乙型肝炎患者对HBVYMDD变异的影响。方法将74例未间断服用拉米夫定治疗1年的未发生YMDD变异的慢性乙型肝炎患者分为对照组34例,治疗组40例,治疗组给予拉米夫定联合清肝解毒汤治疗、对照组给予单独服用拉米夫定治疗,治疗6个月,观察患者YMDD变异、ALT水平的变化。结果治疗3个月后,治疗组YMDD变异发生率为8%,对照组YMDD变异发生率为25%,两组比较,差异无统计学意义(P>0.05);治疗6个月后,治疗组治疗YMDD变异发生率为14%,对照组YMDD变异发生率为37%,两组比较,差异有统计学意义(P<0.05);治疗组与对照组血清丙氨酸氨基转移酶比较,差异无统计学意义(F=0.238,P>0.05);治疗前后血清丙氨酸氨基转移酶比较,差异无统计学意义(F=0.185,P>0.05)。结论清肝解毒汤联合拉米夫定可减少HBVYMDD变异的发生。

Objective To observe effect of Lamivudine in combination with Qingganjiedutang on pol gene mutation （YMDD） in patients with chronic hepatitis B of stagnation of liver-qi with spleen deficiency. Methods Seventy-four cases with chronic hepatitis B treated by Lamivudine for one year without YMDD mutation were randomly divided into 2 groups, including 40 cases of treated group and 34 cases of control group. The treated group was administered with Lamivudine in combination with Qingganjiedutang for 6 months, while the control group was given only Lamivudine for 6 months. YMDD mutation and ALT levels were observed. Results After treating 3 months, YMDD mutation rate was 8% in the treated group and 25% in the control group. No statistical significance was found between the two groups （P〉0.05）. After treating 6 months, YMDD mutation rate was 14% in the treated group and 37% in the control group. There was statistical significance between the two groups （P〈0.05）. Difference in serum alanine aminotransferase was of no statistical significance between the two groups （F=0.238, P〉0.05）, and it was also no statistical significance between pretherapy and post-treatment （F=0.185, P〉0.05）. Conclusions Lamivudine in combination with Qingganjiedutang can reduce the incidence of YMDD mutation in patients with chronic hepatitis B.