拉米夫定治疗代偿期乙型病毒性肝炎肝硬化患者疗效观察

Long-term Efficacy and Safety of Lamivudine for Treatment of Compensated Cirrhosis Due to Hepatitis B

目的:观察拉米夫定治疗代偿期乙型肝炎肝硬化的疗效。方法:20例HBeAg阳性和27例HBeAg阴性的代偿期乙肝肝硬化患者接受拉米夫定治疗,观察两组治疗12周、24周和240周时的疗效。结果:在治疗12周时HBeAg阳性组HBV-DNA转阴18例(90.0%)、24周时HBV-DNA转阴15例(75.0%)、240周时转阴15例(75.0%),P分别为0.478、0.726和0.023:而HBeAg阴性组HBV-DNA在12周、24周和240周时分别转阴21例(77.8%)、19例(70.4%)、27例(100.0%);两组在12周、24周和240周时ALT复常率均无显著性差异(P=0.886、0.537和0.805);在27例HBV-DNA定量>106copies/mL与20例HBV-DNA定量<106copies/mL两组中,治疗12周、24周和240周时HBV-DNA转阴例数分别为19例(70.0%)和20例(100%,P=0.047)、17例(63.0%)和17例(85.0%,P=0.129)、22例(81.5%)和20例(100.0%,P=0.204)。两组在12周、24周和240周时ALT复常率均无显著性差异(P=0.314、0.978和1.0)。结论:拉米夫定治疗代偿期乙肝肝硬化有很好的抗病毒活性。

Objective： To investigate the efficacy and safety of lamivudine in patients with compensated cirrhosis due to hepatitis B. Methods： Twenty HBeAg-positive compensated cirrhosis due to hepatitis B patients and 27 HBeAg-negative chronic hepatitis B patients admitted to our hospital from April 2000 to April 2005 received la- mivudine for 5 years. The efficacy was evaluated at 12, 24, and 240 weeks after initial treatment. Results： In HBeAg-positive group, levels of HBV-DNA less than 1000 copies/ml were achieved in 18（90.0%, P=0.478）,15 （75.0%, P=0.726）, and 15（75.0%, P=0.023） patients at 12, 24, and 240 weeks after treatment, respectively; and in HBeAg-negative group, levels of HBV-DNA less than 1000 copies/ml were achieved in 21（77.8%）,19（70.4%）, and 27（100.0%） patients at 12, 24, and 240 weeks after treatment, respectively. Levels of alanine aminotransferase （ALT） normalized in the 2 groups did not differ at 12, 24, and 240 weeks after treatment（P=0.886, 0.537, 0.805）. In 27 patients with levels of HBV-DNA more than 106 copies/ml and 20 patients with levels of HBV-DNA less than 106 copies/ml, levels of HBV-DNA less than 100 eopies/ml were achieved in 19 and 20 （70.0% vs 100%, P=0.047） patients, 17 and 17 （63.0% vs 85.0%, P=0.129）, and 22 and 20 （81.5% vs 100%, P=0.204） at 12, 24, and 240 weeks after treatment, respectively; and no significant difference in ALT normalization rate was noted between the 2 groups（P=0.314,0.978,1.0）. Conclusion： Lamivudine has satisfactory long-term anti-viral effect on compensated cirrhosis from HBV infection.