拉米夫定治疗慢性乙型肝炎患者三年的疗效观察

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

目的探讨拉米夫定(lamivudine,LAM)长期治疗HBeAg阳性和HBeAg阴性的两组慢性乙型肝炎(CHB)患者相关指标之间的关系。方法将63例入院诊断为CHB的患者分为HBeAg阳性CHB患者组(30例)及HBeAg阴性CHB患者组(33例),拉米夫定100mg/d治疗,进行3年的随访观察,同时检测HBV血清标志物、HBV DNA、ALT、AFP等生化指标,并进行χ2检验来分析两组之间的关系。结果 63例CHB患者中,HBeAg阳性患者30例(47.6%),HBeAg阴性33例(52.4%)。拉米夫定治疗两组患者间ALT复常率、HBV DNA阴转率、肝细胞癌发生率及HBsAg阴转率两组比较差异均无统计学意义;其YMDD变异率、肝硬化的发生率两组比较差异均有统计学意义(P<0.05)。HBeAg阳性组YMDD变异率为43.3%,显著高于HBeAg阴性组的18.2%(χ2=4.720,P<0.05);HBeAg阴性组肝硬化患者占37.0%,显著高于HBeAg阳性组的5.9%(χ2=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 relationships of indicators between HBeAg-positive and HBeAg-negative chronic hepatitis B（CHB）patients in the treatment of lamivudine for the long-term.Methods Sixty-three patients with chronic hepatitis B from January 2006 to January 2009 were studied.The patients were divided into two groups,one with HBeAg-positive（30 cases）and the other with HBeAg-negative（33 cases）.All patients were treated with lamivudine（100 mg/d）then were observed for three years.The serum HBV markers,HBV DNA,ALT,AFP and other biochemical indicators were detected and the measurement data were compared between the two groups by chi square test.Results All the 63 patients with chronic hepatitis B,30（47.6%）patients were HBeAg-positive and the remaining 33（52.4%）were HBeAg-negative.There were no significant difference of the ALT,HBV DNA,the incidence of hepatocellular carcinoma and the ratio of HBsAg-negative conversion between HBeAg-positive and HBeAg-negative groups in the treatment of lamivudine,However,between the two groups the ratio of YMDD mutation and the incidence of liver cirrhosis showed statistical significance（P0.05）.The ratio of YMDD mutation of HBeAg-positive patients was 43.3%,which was significantly higher than that in HBeAg-negative（18.2%）（χ2=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%）（χ2=3.866,P0.05）.Conclusions CHB patients with HBeAg-positive is more susceptible to YMDD mutation than HBeAg-negative patients but less susceptible to liver cirrhosis.