拉米夫定治疗乙型肝炎病毒感染3年临床观察

Three years clinical observation of lamivudine therapy in patients with hepatitis B infection

目的:探讨拉米夫定治疗乙型肝炎的长期疗效和适当疗程。方法:选择HBsAg、HBeAg和HBVDNA均阳性的成年患者。服用拉米夫定100mg·d-1,治疗3年(156周),观察其对HBVDNA、HBeAg、ALT和病毒变异的影响。结果:拉米夫定对HBVDNA有明显的抑制作用,对维持ALT的正常有一定疗效,治疗2年有39.8%的患者发生病毒变异;可出现HBVDNA的反跳。拉米夫定的疗效与患者治疗前ALT和HBVDNA的水平相关。拉米夫定的不良反应轻微,患者耐受性好,可长期服用。结论:拉米夫定治疗HBV感染,对抑制HBV的病毒复制和维持患者的ALT正常有显著疗效;其临床应用的最佳适应证为HBeAg和HBVDNA均阳性,HBVDNA水平较低而ALT异常的患者。拉米夫定的长期疗效与乙型肝炎病毒的变异相关。

Objective:To evaluate the long-term efficacy and appropriate course of lamivudine for hepatitis B virus infec-tion.Method:Adults who were HBsAg,HBeAg,and HBV DNA positive were enrolled in this study.Lamivudine was given100mg daily for three years(156weeks)and its effects on HBV DNA,HBeAg,ALT and HBV mutation was observed.Re -sults:Lamivudine had an obvious inhibiting effect on HBV DNA,and was effective for keeping ALT normal.At the second year,virus mutation occurred in39.8%of patients,partly with rebound of HBV DNA level.The effects of lamivudine were associated with ALT and HBV DNA level of patients before treatment.It was safe with good tolerance and its adverse reac-tions were mild.Conclusion:Lamivudine is good for inhibiting replication of virus and maintenance of normal ALT.Patients with positive HBeAg and HBV DNA,lower DNA level and higher ALT level are the best candidates of lamivudine treatment.Its long-term effects for HBV infection are related to HBV mutation.