阿德福韦酯对HBeAg阳性慢性乙型肝炎的疗效研究

Clinical efficacy of adefovir dipivoxil in treatment of chronic hepatitis B in patients with HBeAg tested positive

目的观察阿德福韦酯佐治拉米夫定耐药型HBeAg阳性慢性乙型肝炎的临床疗效,关注治疗对血清中白细胞介素-12(IL-12)和白细胞介素-18(IL-18)的影响。方法收集医院确诊的拉米夫定耐药型HBeAg阳性慢性乙型肝炎患者132例,依入院顺序和随机区组的原则分为两组,观察组66例,应用阿德福韦酯和拉米夫定进行临床治疗,对照组66例,单纯应用阿德福韦酯治疗,观察两种方法的疗效及对血清中IL-12和IL-18表达的影响,采用SAS6.12软件进行统计分析。结果观察组的ALT、AST、T-Bil的下降值分别为(175.42±34.24)U/L、(80.40±15.42)U/L、(29.64±8.57)μmol/L,对照组分别为(124.40±24.36)U/L、(56.57±12.87)U/L和(15.69±2.35)μmol/L,观察组明显高于对照组,两组比较差异有统计学意义(P<0.05);观察组HBV-DNA和HBeAg转阴率分别为69.70%和57.58%,对照组分别为46.97%和34.85%,观察组明显高于对照组,两组比较差异有统计学意义(P<0.05);观察组治疗后血清中IL-12和IL-18分别为(67.80±13.58)μmol/L和(79.75±19.86)μmol/L、对照组分别为(89.86±28.76)μmol/L和(97.80±24.46)μmol/L,观察组的表达明显低于对照组,两组比较差异有统计学意义(P<0.05)。结论阿德福韦酯联合拉米夫定治疗拉米夫定耐药型HBeAg阳性慢性乙型肝炎的临床疗效理想,且能有效下调血清中IL-12和IL-18的表达,进而调节机体的内环境,临床治疗中可以积极应用。

OBJECTIVE To observe the clinical efficacy of adefovir dipivoxil in treatment of chronic hepatitis B in patients with lamivudine-resistant HBeAg tested positive and explore the impact on levels of serum interleukin-12 （IL-12） and interleukin-18 （IL-18）. METHODS Totally 132 patients with confirmed lamivudine-resistant HBeAg chronic hepatitis B were enrolled in the study and randomly divided into the observation group with 66 cases and the control group with 66 cases according to the order of admission to hospital, the observation group was treated with adefovir dipivoxil and lamivudine, while the control group was given the single adefovir dipivoxil, then the therapeutic effects were observed, the impact on the expression of serum IL-12 and IL-18 was evaluated, and the statistical analysis was performed with the use of SAS6.12 software. RESULTS The decrease value of ALT was （175.42±34.24）U/L in the observation group, （124.40± 24.36）U/L in the control group; the decrease value of AST was （80.40±15.42）U/L in the observation group, （56.57±12.87）U/L in the control group; the decrease value of T-Bil was （29.64±8.57）μmol/L in the observation group, （15.69±2.35）μmol/L in the control group, the differences between the two groups were significant （P〈0.05）. The negative rate of HBV-DNA was 69.70% in the observation group, 46.97% in the control group; the negative rate of HBeAg was 57.58% in the observa- tion group, 34.85% in the control group, the differences between the two groups were significant. After the treat- ment, the level of serum IL-12 was （67.80±13.58）μmol/L in the observation group, （89.86±28.76）μmol/L in the control group; the level of serum IL-18 was （79. 75 ± 19. 86）μmol/L in the observation group, （97. 80 ±24.46）μmol/L in the control group, the differences between the two groups were significant （P〈0.05）. CONCLUSION The adefovir dipivoxil combined with lamivudine can achieve ideal elinieal effect on treatment of lamivudine-resistant HBeAg-positive chronic hepatitis B and effectively reduce the expression of serum IL-12 or IL- 18 so as to regulate the body＇s internal environment, and it is worthy to be promoted in the clinical treatment.