拉米夫定预防免疫抑制剂治疗引起HBV再激活的疗效及其耐药性分析

Prevention of hepatitis B virus(HBV)reactivation in patients after recei ving immunosppressive agents by lamivudine:curative effect and drug resistant analysis

目的:观察拉米夫定预防免疫抑制剂治疗后引起乙型肝炎病毒再激活的临床疗效,为此类特殊慢性乙型病毒性肝炎(乙肝)人群预防HBV激活提供依据。方法:选择患有血液病、肾病等基础疾病需接受免疫抑制剂治疗同时伴有乙型肝炎病毒(HBV)感染者65例为研究对象,将其分为HBeAg阳性组(n=40)和HBeAg阴性组(n=25),评价患者的生化学应答、病毒学应答及血清学应答,分析其耐药性。结果:在治疗12周、24周、48周时,65例患者总生化学应答率分别为64.29%、85.71%、75.00%,总HBV DNA阴转率分别为65.12%、74.42%、65.12%,HBeAg阳性组患者的HBeAg阴转率为4.65%、9.30%、18.60%;48周时,HBeAg血清转换率为13.95%;在12周时HBeAg阴性组与HBeAg阳性组生化学应答率有统计学意义(P<0.05),其余两个时段比较,差异均无统计学意义(P>0.05);48周时有6例出现HBV DNA复阳伴ALT升高,有5例加用阿德福韦酯后再次阴转,有3例患者在48周时出现HBsAg阴转;12周、24周时无耐药出现,48周时耐药率为9.23%。结论:使用免疫抑制剂治疗基础病的HBV感染者服用拉米夫定可以有效预防HBV再激活,但需注意其耐药性。

Objective：To observe the prevention effect of lamivudine on HBV reactivation in patients after receiving immunosuppressive agents and analyse its drug resistance,for this particular HBV activation providing the prevention basis.Methods：Sixty and five patients suffered from blood diseases,kidney diseases respectively,due to HBV infection need of receiving immunosuppressive and anti-HBV infection therapy were selected as the study object.Which were divided into HBeAg positive group（n=40） and HBeAg negative group（n=25）,the biochemical response,virological response and serological response,and drug resistance were observed and analysed.Results：In the treatment of 12 weeks,24 weeks,48 weeks,65 patients underwent total biochemical response rates were 64.29%,85.71%,75.00%,the total HBV DNA seroconversion rates were 65.12%,74.42%,65.12%,HBeAg positive group the negative rates of HBeAg were 4.65%,9.30%,18.60%;In the treatment of 48 weeks,HBeAg seroconversion rate was 13.95%;In 12 weeks between HBeAg negative group and HBeAg positive group the biochemical response rate was statistically significant（P〈0.05）,the remaining time（24 weeks,48 weeks）between two groups were not statistically significant（P〈0.05）.At 48 weres,there were 6 cases with positive HBV DNA complex and ALT rebound.There were 5 cases among the 6 cases again seroconversion affer addition of adefovir dipivoxil.There were 3 patients at 48 weeks HBeAg seroconversion In 12 weeks,24 weeks without drug resistance.The resistant rate was 9.23% at 48 weeks.Conclusion： When the patients with fundament diseases and HBV infection need of receiving immunosuppressive and anti-HBV infection therapy,lamivudine can be effective in preventing HBV reactivation,but should take note of its drug resistance.