拉米夫定治疗慢性重型肝炎疗效观察

Treatment effect of lamivudine on chronic severe hepatitis B

将 45例慢性重型乙型肝炎患者随机分为治疗组 2 2例、对照组 2 3例。治疗组在综合保肝治疗的基础上口服拉米夫定 10 0 mg、每日 1次 ,对照组仅用综合保肝治疗 ,疗程均为 1年 ;观察症状、体征、肝功能、血清HBVM和 HBVDNA的变化。结果显示 ,治疗后两组患者症状体征均有一定程度的改善 ;治疗结束时 ,治疗组治愈好转率 (95 .45 % )高于对照组 (73.91% ) ,病死率 (4 .5 % )低于对照组 (17.39% ) ,P均 <0 .0 5。治疗前治疗组 13例 HBVDNA阴性、9例阳性 (6 5 0 .47± 5 97.2 2 fg/ ml) ,治疗后阴性者持续阴性 ,阳性者均逐渐转阴 ;对照组 15例HBVDNA阴性、8例阳性 (5 79.5 2± 5 42 .86 fg/ ml) ,治疗后阴性者 6例阳转 ,阳性者持续阳性。治疗 3个月时 ,治疗组 AL T复常率高于对照组 ;治疗 8个月后治疗组复发率 4.7% (1/ 2 1) ,对照组为 5 7.14% (8/ 14) ,P<0 .0 1。提示拉米夫定治疗慢性重型乙型肝炎可使病毒持久转阴 ,复发率和病死率低。

patients with chronic severe hepatitis B were enrolled and randomized into treatment group (22 cases)and control group(23 cases) Treatment group received colligative treatment and lamivudine 100mg daily and control group received colligative treatment for one year The clinical,biochemical,virological parameters were observed Results showed that the clinical syndroms and signs were improving in two group after treatment Cure and improvement rates of treatment group were higher than that of control group(95 45% vs73 91%,P<0 05) Mortality of treatment group was lower than that of control group(4 5% vs17 39%,P<0 05) Before treatment,HBVDNA was negative in 13 cases and positive in 9 cases (650 47±597 22fg/ml)of treatment group,HBVDNA in 13 negative patients was continuelly negative and HBVDNA in 9 positive patients was getting negative after treatment Before treatment,HBVDNA was negative in 15 cases and positive 8 cases (579 52±542 86fg/ml)of control group HBVDNA of 6 cases of 15 negative patients were getting positive and of 8 cases in positive patients was continuelly positive after treatment By month 3,ALT normalization rate of treatment group was higher than that of control group(P<0 05) By month8,recurring rate was 4 7%(1/21)of treatment group,but 57 14%(8/14) in control group,P<0 01 This suggests that lamivudine might make HBVDNA be lasting negative,recurring rate and mortality are lower to patient with chronic severe hepatitis B