拉米夫定治疗晚期血吸虫病合并慢性乙型病毒性肝炎

A clinical study on lamivudine treatment for advanced schistosomisis with Chronic B Hepatits

目的探讨晚期血吸虫病合并慢性乙型肝炎患者应用拉米夫定(LVD)治疗的临床效果及对病程进展的影响。方法 58例晚期血吸虫病合并慢性乙型肝炎患者随机分成治疗组(30例)和对照组(28例)。治疗组服用LVD100 mg/d,同时给予常规综合治疗。对照组仅给予常规综合治疗,随访时间为36±3个月。结果治疗组和对照组死亡率分别为13.33%和55.56%(P<0.01),Child Pugh评分下降≥2分的患者分别为89.1%和62.3%(P<0.05)。治疗组在降低血清胆红素和转氨酶、升高血清白蛋白水平、改善肝功能方面均明显优于对照组(P<0.01)。治疗组HBV DNA和HBeAg转阴率明显高于对照组(P<0.01)。治疗组在12周时HBV DNA转阴率为93.3%,治疗组在48、96、144周时LVD发生TMDD变异率分别为6.7%、23.3%和40%。大多数发生变异的患者联合阿德福韦酯(ADV)治疗可抑制乙肝病毒复制,肝功能保持相对稳定。结论对晚期血吸虫病合并慢性乙型肝炎患者应用LVD治疗可以快速抑制乙肝病毒复制,改善肝功能,延缓病情进展。LVD联合ADV可抑制大多数YMDD变异患者的病毒复制,改善肝功能。

Objectve to explore the clinical effect of LVD on patients with advanced schistosomiasis with chronic B hepatitis and on the course of disease development. Methods A total of 58 patients with advanced schistosomiasis with chronic B hepatitis were enrolled and randomly divided into the treatment group（30 cases） and the control group（28 cases）.patients in the treatment group received routinet colligative treatment and LVD 100mg daily, while patients in the control group received routinet colligative treatment only.All the patients were followed up for 36 ＋ 3 months. Results The mortality rate was 13.33% vs 55.56% in the treat- ment and control（P 〈 0.01）. The patients whose Child-Pugh score decreased by more than 2 were 89.2% vs 62.3% （P 〈 0.05）. Af- ter treatment the serum ALT TBIL levels dropped, the serum albumin level increased and The improvement of liver function in the treatment group was better than that in the control group （P 〈 0.01）.The HBeAg and HBV-DNA negutive rate in the treatment group were higher than those in the control（P 〈 0.01 ）.The HBV-DNA negative rate in thetreatment group was 93.3% at the end of 12 weekes. The rate of YMDD mutations was 6.7%, 23.3% and 40% in the treatment group at the end of 48,96 and 144 weekes. LVD and ADV can inhibit virus replication and the relative stability liver function remained the same in most YMDD mutation pa- tients. Conclusion LVD can inhibit virus replication rapidly and improveliver function, prevent exacerbation in patients with ad- vanced schistosomiasis with chronic B hepatitis , LVD and ADV can inhibit virus replication and improve liver function in most YMDD mutation patients.