88例慢性乙肝患者拉米夫定抗病毒治疗停药后复发治疗方案探讨

Discussion on recurrence therapeutic schemes of 88 cases of chronic hepatitis B patients after discontinuation of lamivudine antiviral treatment

目的探讨拉米夫定治疗慢性乙型肝炎(简称乙肝),停药后复发使用氧化苦参素、干扰素-α-2b(IFN-α-2b)、阿德福韦酯的治疗效果。方法按临床随机数字表法将2008—2014年本院感染科88例经拉米夫定治疗停药后复发的乙肝患者分为A和B组:A组45例,行IFN-α-2b、阿德福韦酯、氧化苦参素治疗,B组43例,行拉米夫定治疗。观察比较两组患者停药后HBVDNA标志物、肝功能、乙肝病毒标志物阴转率、HBV多聚酶YMDD基因变异4项指标。结果 A组患者的肝功能、HBV-DNA标志物、乙肝病毒标志物阴转率和HBV多聚酶YMDD基因变异4项指标均优于B组(P<0.05)。结论乙肝患者服用拉米夫定进行抗病毒治疗停药后复发,采用IFN-α-2b、阿德福韦酯、氧化苦参素联合治疗效果显著,值得临床推广应用。

[Objective]To discuss the treatment effect of using oxidation matrine, IFN-α-2b and adefovir dipivoxil for chronic hepatitis B that recurrence from stopping receiving treatment of lamivudine. [Methods]A total of 88 cases of Hepatitis B patients who stopped receiving the treatment of lamivudine and then recured in the infection department in our hospital during 2008-2014 were selected and divided into A and B groups by clinical random number table method. 45 patients in A group received the treatment of combination of oxidation matrine,IFN-α-2b and adefovir dipivoxil and 43 patients in B group received the single treatment of lamivudine. The HBV DNA biomarker,liver function,negative conversion rate of Hepatitis B virus markers and HBV polymerase YMDD gene variation of two groups patients were observed and compared.[Results]The liver function,HBV DNA biomarker,negative conversion rate of Hepatitis B virus markers and HBV polymerase YMDD gene variation in group A were better than group B（P〈0.05）.[Conclusion]The effect is significant for Hepatitis B patients using IFN-α-2b,adefovir dipivoxil and oxidation matrine combination therapy after recurrence from stopping receiving antiviral treatment of lamivudine,which is worthy for clinical application.