拉米夫定治疗慢性乙型肝炎患者血清HBV-DNA水平和肝组织学的关系

Concentration of Serum HBV-DNA during Therapy with Lamivudine and Correlation with Hepatic Histology in Patients with Chronic Hepatitis B Infection

目的观察口服拉米夫定治疗48周对慢性乙型肝炎(CHB)患者血清HBV-DNA水平的影响及其与肝组织学的关系,评估拉米夫定对CHB患者的疗效。方法 60例CHB患者均来自本院2009-03～2012-03住院患者,给予口服拉米夫定100 mg/d,于治疗前和治疗后应用RT-PCR检测法检测血清HBV-DNA水平,治疗48周后进行肝组织穿刺,标本进行炎症活动度分级(G)及纤维化程度分期(S)。结果拉米夫定治疗12和24周血清HBV-DNA的水平和治疗前比较没有明显差异(P>0.05),治疗36、48周后血清HBV-DNA水平较治疗前明显降低(P<0.05);治疗48周后血清HBV-DNA水平与肝组织炎症活动度(G)(r=-0.452,P=0.017)及纤维化程度(S)(r=-0.571,P=0.001)呈负相关。结论拉米夫定可以降低CHB患者血清HBV-DNA的水平;治疗48周后血清HBV-DNA水平与肝组织炎症活动度(G)分级和纤维化程度(S)分期呈负相关,该结果为拉米夫定治疗CHB患者疗效的评估提供实验依据。

Objective To observe the concentration of serum HBV-DNA in patients with chronic hepatitis B （CHB） after treated by lamivudine orally for 48 w, and evaluate the correlation between the treatment and change of liver histology. Methods A total of 60 patients of CHB who were selected from 2009 -03 -2012 -03 in the inpatients of the hospital were treated by lamivudine （oral, 100 rag/d） for 48 w. The concentration of serum HBV-DNA were detected by real time PCR before and after the treatment. The liver biopsy was done at end of 48 weeks, and the samples were classified according to the inflammation activity of liver tissue. Results The concentration of serum HBV-DNA had no significant difference （P 〉 0.05 ） after treated for 12 and 24 w by lamivudine, but was decreased significantly after treated for 36 and 48 w （P 〈 0.05 ）. Serum HBV-DNA concentration was negatively correlated with the grade of hepatic-necro inflammation （r= -0. 452, P 〈0.05） or the stage of fibrosis （r = -0. 571, P 〈0.05） after treated for 48 w. Conclusion The concentration of serum HBV-DNA can be significantly reduced after treated by lamivudine. There is significant negative correlation between serum HBV-DNA levels and hepatic histology change after treated by lamivudine for 48 w, which would provide experiment evidence for evaluating the effency of lamivudine.