拉米夫定治疗慢性乙肝型炎过程中的HBV变异及其临床意义

The effect of Lamivudine on the mutation in hepatitis B virus and its clinical significance

目的探讨拉米夫定在慢性乙型病毒性肝炎治疗过程中的HBV变异及其临床意义。方法对86例患者予拉米夫定100mg,1次/d,共治疗104周。观察SB,ALT,PA,HBeAg,抗-HBe,YMDD变异株。结果52周、104周,YMDD变异率分别为11.6%、30.2%。变异者ALT>40U/L,未变异者ALT保持正常,无反复;且变异者HBeAg无1例阴转。继续观察治疗变异者,第76周有部分出现HBeAg阴转及HBeAg/抗-HBe血清转换。有6例在51～78周停药后,发生重症肝炎,但血清中未检测出YMDD变异株。结论随服药时间延长,变异率升高;拉米夫定对部分YMDD变异者似有一定疗效;停服拉米夫定后发生的重症肝炎与YMDD变异无明显相关性。

Objective To explore the effect of Lamivudine on the mutation in hepatitis B virus and its clinical significance.Methods All the86patients with chronic hepatitis were treated with Lamivudine100mg ,once a day for104weeks,and their serum SB,ALT,PA,HBeAg,anti-HBe level and YMDD mutation were investigated.Results YMDD mutation rates at the52th and the104th week were11.6%and30.2%respectively and the serum ALT level was different between patients with and without YMDD mutation(>40IU/L,<40IU/L).At the72th week HBeAg got negative anti-HBe occurred in patients without YMDD mutation but 6cases of severe hepatitis happen at51-78weeks.Conclusion Lamivudine seem s to be effective on the patients with YMDD mutation hepatitis B YMDD mutation rate associated with Lamivudine therapeutic time and not associated with severe hepatitis occurrence.