拉米夫定治疗慢性乙型肝炎12周病毒学应答预测96周疗效

Virology response of lamivudine treating for chronic hepatitis B patients at week 12 predict the 96 week effect

目的研究拉米夫定治疗慢性乙型肝炎12周HBV DNA定量检测结果对治疗96周疗效HBV DNA<103拷贝/ml比例、HBeAg血清学转换率和耐药发生率的预测价值。方法观察189名慢性乙型肝炎患者使用拉米夫定,100mg/d,口服。根据12周血清HBV DNA<103拷贝/ml或≥103拷贝/ml将患者分为A、B组,继续治疗至96周。分别于0、4、12、24、36、48、60、72、84、96周检测血清HBV DNA定量、HBV血清标志物。分析96周时2组疗效的差异。结果该组病例189例在治疗4周、12周、24周HBV DNA达到检测线以下分别61、117、124人(百分比分别为32.27%、61.91%、65.61%),且96周时仍维持在检测水平以下者比例均在70%以上。治疗4周时已达HBV DNA<103拷贝/ml患者突破反弹者为21.74%,≥103拷贝/ml为61.67%;治疗12周时达到HBV DNA定量检测水平以下者或仍≥103拷贝其后发生HBV DNA分别为27.35%,75.00%;24周分别为28.23%,69.81%。A组96周时血清HBV DNA<103拷贝/ml比例为70.09%,高于B组(22.22%);HBeAg血清学转换率A组为63.89%、B组为16.39%;酪氨酸-蛋氨酸-天门冬氨酸-天门冬氨酸(YMDD)变异率A组为4.27%小于B组(12.50%)。结论使用拉米夫定治疗慢性乙型肝炎,12周时HBV DNA<103拷贝/ml可以预测96周疗效,减少耐药发生。

Objective To discuss the value that HBV DNA level in the weekl2 forecast the rate of HBV DNA 〈 103eopies/ml, serological conversion of HBeAg and the resistance in the 96th week. Methods A total 189 patients received lamivudine orally in a single daily dose of 100 mg for 96 weeks, According to serum HBV DNA 〉 103copies/ml and HBV DNA 〈 103copies/ml at week 12, all the patients were divided into A group and B group, and continue to treat until week 96. Patients were assessed at baseline and week 4, 12, 24, i 36, 48, 60, 72, 84, 96 after the initiation of therapy, every twelve weeks until week 96. Blood samples were drawn at each visit to monitor HBV markers, HBV DNA. Results The rates of the patients whose HBV DNA 〈 109 eopies/ml at week 4, 12, 24 were 32.27%, 61.91%, 65.61%, and the undetectable HBV DNA levels at week 96 were up to 70%. The Virologic breakthrough of the patients whoes HBV DAN 〈 103 copies/ml or HBV DAN 〉 103at week 4 was21： 74% or 61.67% respectively to week 96; it of the patientswhoes HBV DAN 〈 103 copies/ml or HBV DAN 〉~103at week 12 was 27.35% or 75[00% respectively; at week 24 was 28.23% o 69.81% respectively. There remained 70.09% patients in group A whose HBV DNA 〈 103 copies/ml at 96＇h week, higher than those patients ingroup B （22.22%） ; serological conversion of HBeAg was 63.89% in group A and 16.39% in group B. YMDD aberration rate was 4.27% in group A lower than 12. 50% in group B. Conclusion In the chronic hepatitis B patients receiving the treatment of Lamivudine, HBV DNA less thanl03 copies/ml at week 12 can predict effect at week 96 and reduce the virologic breakthrough.