拉米夫定经治慢性乙型肝炎患者治疗现状调查分析

The current status of lamivudine-treated patients with chronic hepatitis B

目的了解我国拉米夫定(LAM)经治慢性乙型肝炎(慢性乙肝)患者的治疗情况,为进一步优化慢性乙肝患者的治疗方案提供依据。方法采用问卷调查形式,调查全国110个城市741家医院的684名医师及其LAM经治慢性乙肝患者情况。结果 684名医师中,采取LAM经治患者占39.62%(271人);65.50%(448人)医师认为患者可承担抗病毒药物的费用为每月500～1000元。LAM经治慢性乙肝2 396例HBeAg阳性患者中,自行停药、疗效不佳停药和达到停药标准停药者分别占46.74%、23.04%和30.22%;LAM经治慢性乙肝1 046例HBeAg阴性患者中,自行停药、疗效不佳停药和达到停药标准停药者分别占48.95%,22.47%和28.59%,两者差异无统计学意义(P>0.05)。在1 632例自行停药者中,1年、2年、3年累计停药率分别为24.27%、58.77%、80.58%;在787例疗效不佳停药者中,1年、2年、3年累计停药率分别为18.93%、55.14%、78.53%;在1 023例达到停药标准停药者中,治疗2～3年者占46.53%,3年以上者占53.47%。在1年内停药545例LAM经治慢性乙肝者中,72.66%为自行停药,27.34%为疗效不佳停药;1 393例2年内停药者中,68.84%为自行停药,31.16%为疗效不佳停药;3年内停药者中,54.59%(1 315/2 409)为自行停药,25.65%(618/2 409)为疗效不佳停药,19.76%(476/2 409)为达到停药标准停药;3年以上停药者中,30.69%(317/1 033)为自行停药,16.36%(169/1 033)为疗效不佳停药,52.95%(547/1 033)为达到停药标准停药。结论我国LAM经治患者所占比例较高,其经济承受力有限,依从性差,因此,优化拉米夫定经治慢性乙肝患者的治疗和提高其依从性十分重要。

Objective To investigate the current status of lamivudine（LAM）-treated patients with chronic hepatitis B（CHB） in China,and to provide the basic data for further optimizing the treatment of CHB patients.MethodsA questionnaire survey was conducted in this study.A total of 684 hepatologists from 741 hospitals selected from 110 cities of China,and the CHB patients treated by LAM were enrolled in this study.ResultsAccording to data provided by 684 hepatologists,39.58%（271/684） of patients were treated by LAM,and 65.50%（448/684） of them could pay 500 to 1,000 yuan per month for the cost of antiviral therapy.Among HBeAg-positive patients treated with LAM,the proportions of treatment withdrawals by patients themselves,with poor efficacy and meeting the endpoint of therapy were 46.74%（1120/2396）,23.04%（552/2396） and 30.22%（724/2396）,respectively.Among the HBeAg-negtive group,the figures were 48.95%（512/1046）,22.47%（235/1046） and 28.59%（299/1046）,respectively.There was no significant difference between the two groups（P〉0.05）.Among the 1632 CHB patients with patients self-withdrawal, the gross cumulative discontinuation rates of antiviral therapy at 1,2,3 years were 24.26%,58.26% and 80.58%,respectively.The figures for the 787 cases with withdrawal of poor efficacy were 18.93%,55.14%, 78.53%,respectively.Of the 1023 CHB patients with withdrawal of meeting the endpoint of treatment,46.53% had treated for 2-3 years,and 53.47% for over 3 years.The reasons for LAM treatment withdrawal within 1 year of the CHB patients were self-withdrawal in 72.66%（396/545）,poor efficacy in 27.34%（149/545） and meeting the endpoint of treatment in 0.The figures were 68.84%（959/1393）,31.16%（434/1393） and 0 for the patients of withdrawal within 2 years;54.59%,25.65%（618/2409） and 23.23%（476/2409） for those of withdrawal within 3 years;30.69%（317/1033）,16.36%（169/1033） and 52.95%（547/1033） for those of withdrawal over 3 years.ConclusionsA significant proportion of CHB patients are treated with LAM in China at present.Their economic affordability and treatment compliance are poor.Therefore,it is important to optimize the LAM therapy strategy and to improve the treatment compliance of CHB patients.