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三联叠加疗法对慢性乙肝患者HBV复制和变异的影响

Effects of a Triplex Superimposed Treatment on HBV Replication and Mutation in the Treatment of Chronic Hepatitis B
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摘要 目的 :应用抗病毒药物和免疫调节剂 ,观察其对慢性乙肝病人HBV复制和变异的影响。方法 :(1)用一种以拉米夫定为基础的拉米夫定 +干扰素α - 2 β +黄芪注射液“三联叠加疗法” ,对慢性乙肝病人进行抗病毒治疗 ,并与单独应用拉米夫定的抗HBV效果进行比较 ;(2 )疗效观测指标 :①ALT复常率 ;②HBV DNA阴转率和HBeAg 抗HBe血清转换率 ;③血清HBV DNA浓度 ;④HBV DNA的YMDD变异率和前C区BCP变异率。结果 :(1)三联叠加用药组ALT复常率在治疗后第4、12及 48周显著高于拉米夫定单药组 (P <0 .0 5 ) ,特别在治疗第 36周 ,单药组ALT复常率为 6 3.38% ,而叠加组达 84.2 1% ;(2 )两组的HBV DNA阴转率在第 12、36及 48周有显著差异 (P <0 .0 5 ) ,HBeAg阴转率在第 36、48周亦有显著差异 (P <0 .0 5 ) ,而抗HBe阳转率仅在第 48周出现差异 (P <0 .0 5 ) ;(3)治疗后第 4周 ,两组患者的血清HBV DNA浓度较治疗前有显著降低 (P <0 .0 1) ,治疗 12周时叠加组HBV DNA滴度下降较对照组显著 ,至 36、48周时两组有显著性差异 ;(4 )治疗后 12周 ,叠加组出现前C区BCP变异 ,疗后 2 4、36和 48周 ,两组均出现YMDD和前C区变异。但 48周时 ,单药组YMDD变异率明显增加 ,前C区变异率则降低 ,而叠加组YMDD变异略增加 ,前C区变异无变化。 Objective: To observe and evaluate the effects of a new antiviral treatment scheme on HBV replication and mutation in the treatment of chronic hepatitis B. Methods: (1) A triplex superimposed treatment mainly with Lamivudine combined with IFNα 2β and Astragalus injecting agent was given to patients with chronic HBV, and a comparison of the effects on HBV was made between the above treatment group and the Lamivudine alone group; (2) The indices indicating treatment effects were: ALT normalization rate, HBV DNA negative rate (serum HBV DNA<1.6ng/L)and HBe seroconversion rate; (3) HBV DNA serum level; (4) HBV YMDD mutation rate and pre C region mutation rate. Results: (1) ALT normalization rate of the test group was notably higher than that of the control group at week 4、12 and 48(P<0.05), and especially higher at week 36(84.21% vs 63.38%, P<0.01); (2) Compared with that of the contral group, HBV DNA negative rate of the test group increased markedly at week 12、36、48(P< 0.05 ). HBeAg negative rate of the group increased markedly at week 36、48(P<0.05),while anti HBe positive rate increased only at week 48(31.58% vs 19.23%,P<0.05); (3) After a 4 week treatment, HBV DNA serum level of both the test group and the control group reduced remarkably(P<0.01), and at week 48, reduced more significantly(P<0.001). When compared with the control group, HBV DNA serum level of the test group reduced notably at week 12(P<0.05) and very notably at week 36 and 48(P<0.01); (4) At week 12, the pre C region mutation occured in the test group, and at week 24、36、48, the pre C region and YMDD mutation occurred in both the test group and the control group. It was found that YMDD mutation increased obviously while pre C region mutation reduced in the control group and no obvious change occurred in the test group at week 48. Conclusion: As to anti viral treatment of chronic hepatitis B, the triplex superimposed treatment can achieve better curative effect than lamivudine treatment alone.
出处 《海军医学杂志》 2001年第1期45-49,共5页 Journal of Navy Medicine
关键词 乙型肝炎 变异 三联叠加疗法 HBV 复制 lamivudine interferon astragalus membranaceus triplex superimposed treatment HBV replication and mutation.
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