核苷(酸)类似物联合中药治疗HBV-P基因序列耐药变异研究

Study of nucleosides(acid) analogues combined with traditional Chinese medicine in treatment of drug-resistant HBV-P gene sequence variations

目的观察拉米夫定(LAM)联合扶正化瘀胶囊对HBV-DNA多聚酶的HBV-P基因区(YMDD)变异率的影响。方法将慢性乙型肝炎患者80例随机分为治疗组和对照组各40例,治疗组患者给予LAM联合扶正化瘀胶囊治疗,对照组单用LAM治疗,疗程均为18个月,比较2组患者ALT水平、HbeAg阴转率、HbeAg/抗Hbe血清转换率、HBV-DNA阴转率和YMDD变异率。结果治疗组治疗6个月时ALT高于治疗前,治疗12、18个月时ALT水平低于治疗前,治疗6、9个月时ALT水平高于对照组;对照组各时间点ALT水平均低于治疗前,差异均有统计学意义(P<0.01)。治疗18个月时治疗组HbeAg阴转率、HbeAg/抗Hbe血清转换率、HBV-DNA阴转率高于对照组,YMDD变种率低于对照组,差异有统计学意义(P<0.05)。结论 LAM联合扶正化瘀胶囊有调节慢性乙型肝炎患者细胞免疫水平的作用,可降低YMDD变异率。

Objective To observe the impact of lamivudine （LAM） combined with Fuzheng Huayu capsote on HBV- DNA polymerase YMDD mutation rate. Methods 80 cases of patients with chronic hepatitis b （CHB） were. randomly divided into treatment group and control group. The treatment group was given LAM combined with Fuzheng Huayu capsule for treatment,while the control group was given LAM for treatment. The treatment course of both groups was 18 months. The ALT level, HBeAg negative rate, HbeAg/anti Hbe serum conversion rate, HBV-DNA negative rate and YMDD variation rate of 2 groups were compmred. Results Treatment for 6 months, the ALT level of treatment group was higher that before treatment, 12,18 months after treatment,which was lower than that before treatment; 6,9 months after treatment,the ALT level of the treatment group was higher than that of the control group; the ALT level of the control group was lower than before treatment each time point, the differences were statistically significant （P 〈 0. 01 ）. Treatment for 18 months, the HBeAg negative rate, HbeAg/antiHbe serum conversion rate and HBV-DNA negative rate of the treatment group were higher than those of the control group, YMDD variation rate was lower than that of the control group, the differences were statistically significant （ P 〈 0. 05）. Conclusion LAM conrbined with Fuzheng Huayu capsule has the function in regulating cellular immune of patients with CHB, and can reduce the occurrence of YMDD mutation.