拉米夫定优化α-干扰素治疗慢性乙型肝炎疗效分析

The analysis of lamivudine in optimizing curative effect of interferon-αantiviral treatment in chronic hepatitis B patients

目的评价短期加用拉米夫定优化α-干扰素治疗慢性乙型肝炎的疗效。方法治疗组88例HBeAg阳性慢性乙型肝炎患者使用拉米夫定0.1 g/d,加IFN-α隔日皮下注射抗病毒治疗,对照组43例HBeAg阳性慢性乙型肝炎患者使用聚乙二醇干扰素α-2a(Peg-IFN)单药治疗,疗程均为48周,随访24周。定期进行HBV血清标志物、HBV DNA和肝功能检测,比较两组患者治疗及随访期间血清学和病毒学应答率及复发率。结果治疗组48周、72周HBeAg阴转率分别为42.1%(37/88)、40.9%(36/88),高于对照组的23.3%(10/43)、23.3%(10/43),各时间点差异有统计学意义(P=0.0353;P=0.0468)。治疗组和对照组中24周病毒学应答不佳的病例(HBV DNA较基线下降≤2 lg IU/mL),前者在第36、48和72周HBV DNA阴转率分别为64.6%(31/48)、64.6%(31/48)和68.8%(33/48);高于后者的13.04%(3/23)、26.1%(6/23)和26.1%(6/23),各时间点差异有统计学意义(均P<0.01)。前者在48周、72周HBeAg阴转率分别为45.8%(22/48)、43.8%(21/48),高于后者的13.0%(3/23)、17.4%(4/23),差异有统计学意义(P=0.0068;P=0.0295)。前者在第36、48和72周HBsAg血浆浓度分别为(3.25±0.46)、(3.12±0.64)和(2.92±0.97)lg IU/mL;低于后者的(3.54±0.50)、(3.54±0.52)和(3.44±0.41)lg IU/mL,各时间点差异有统计学意义(P=0.0157、0.0177、0.0090)。结论 HBeAg阳性的CHB患者接受规范的α-干扰素抗病毒治疗过程中,24周病毒学应答不佳的患者短期加用拉米夫定,能提高病毒学和血清学应答,增强抗病毒疗效。

Objective To evaluate curative effect of lamivudine for a short term in optimizing interferon-antiviral treatment in patients with HBeAg positive chronic hepatitis B （CHB）. Methods Eighty-eight CHB cases in treatment group were treated with lamivudine to optimize interferon-antiviral therapy and 43 CHB cases in control group were treated with peginterferonα-2a mono-therapy for 48 weeks. HBV-M,HBV DNA and liver functions of two groups were routinely tested during the treatment and follow-up. Immunological and virological response,recurrence rates were compared between two groups. Results HBeAg loss rates in treatment group at 48th week and 72th week were 42.1%（37/88）and 40.9% （36/88）respectively,higher than those in control group which were 23.3% （10/43）and 23.3%（10/43）respectively,and there were significantly statistic difference at each time point （P= 0.0353;P= 0.0468）. Comparing the poor curative effect （HBV DNA decline ≤ 2log10 IU/mL compared with baseline）of the cases between treatment group and control group,HBV DNA undetectable rates of the former at 36th week,48th week,72th week were 64.6% （31/48）,64.6% （31/48）and 68.8% （33/48）,higher than those of the latter which were 13.04% （3/23）,26. 1% （6/23 ）and 26 .1% （6/23 ）,with a significant difference at each time point （P〈0 .000 1;P= 0 .002 4;P= 0 .0007）. HBeAg loss rates of the former at 48th week,72th week were 45.8% （22/48）and 43.8% （21/48）,higher than those of the latter which were 13% （3/23）and 17.4% （4/23）,and the difference was statistically significant （P= 0.006 8;P= 0.0295）. HBsAg concentrations of the former at 36th week,48th week,72th week were 3.25 ± 0.46,3.12 ± 0.64 and 2.92 ± 0.97,lower than those of the latter which were 3.54 ± 0.50,3.54 ± 0.52 and 3.44 ± 0.41;there were significant differences at each time point （P= 0.015 7;P= 0.017 7;P= 0.009 0）. Conclusion HBeAg positive CHB patients,which treated with lamivudine for a short term based on standard interferon anti-viral treatment and poor effect in 24th week,can improve virological response and optimize the antiviral effect.