拉米夫定治疗慢性乙型肝炎病毒感染的近期疗效

Preliminary trial of lamivudine therapy for chronic HBV infection

目的评价拉米夫定治疗不同临床类型慢性乙型肝炎病毒（HBV）感染的近期疗效。方法口服拉米夫定150mg，每日1次，连服6个月，治疗慢性乙型肝炎病人40例，肝炎肝硬化18例，慢性重型肝炎10例。观察其临床、生物化学、血清学和病毒学改变。结果（1）慢性乙型肝炎病情缓解。对照组病毒血症持续，27．5％病人于随访期内肝炎复发（P＜0．001）。同时观察拉米夫定联用干扰素治疗病人20例，未见提高疗效。（2）肝炎肝硬化病情渐趋稳定，肝功能好转，Child—Pugh积分下降。（3）慢性重型肝炎除2例服药不足3个月死亡外，余8例病情缓解，随着肝功能改善，生活质量显著好转。结论拉米夫定适用于治疗慢性乙型肝炎，对处于HBV复制状态的肝硬化和重型肝炎也有效。

Objective To evaluate the effect of lamivudine therapy on chronic HBV Infection in different clinical types. Methods 68 hospitalized patients with chronic HBV infection and positive for HBV DNA (PCR) in serum were enrolled to receive lamivudine 150mg orally, once daily for six months. Efficacy was assessed by clinical, biochemical, serologic and virologic improvements. Results Lamivudine was safe and well tolerated. Serum HBV DNA fell rapidly to undetectable level in all P8tients but one. (1)In chronic hepatitis B group, 40 cases treated with lamivudine and 40 controlled cases were all resolved aradually from their disease progression. In contrast with lamivudine recipients, HBV viremia still maintained and 11 patients (27.5%) relapsed during 3-6 month follow-up period in the controlled cases (p<0.001).Among lamivudine recipients, there were 20 patients treated simultaneously in combination with alpha interferon 3MU-5MU, intramuscularly tiw for 24 weeks. But by the end of treatment, there was no significant difterence in all resects between lamivudine monotherapy and lamivudine Plus alpha niterteron. (2) The condition of 18 patients with decompensated cirrhosis was tending to be stable, along with liver function improving and Child-Pugh score decreasing. (3) Eight of 10 patients with chronic severe hepatitis had a slow but marked clinical and biochemical improvement in liver function and quality of life. The remaning 2 patients with complications of alcoholic cirrhosis or severe diabetes died of progressing hepatic failure within 3 months of treatment initiation. Conclusion Preliminary data indicate that lamivudine therapy can effectively inhibit HBV replication and significantly improve liver function either in chronic hepatitis B or in those with decompensated cirrhosis or chronic severe hepatitis.[