叶下珠复方和拉米夫定治疗慢性乙型肝炎的临床疗效比较

A Comparative Study on Phyllanthus Compound and Lamivudine in the Treatment of Chronic Hepatitis B

【目的】观察比较叶下珠复方、拉米夫定、叶下珠复方合用拉米夫定治疗慢性乙型肝炎的疗效。【方法】 90例慢性乙型肝炎患者随机分 3组 ,分别为叶下珠复方组 (剂量 2 6g/次 ,3次 /d)、拉米夫定组 (剂量 10 0mg/次 ,1次 /d)和叶下珠复方合用拉米夫定组 ,均连续口服 5 2周。治疗前、后定期检测血清肝功能指标及乙型肝炎标志物表面抗原 (HBsAg)、e抗原 (HBeAg)、乙型肝炎病毒脱氧核糖核酸 (HBV DNA)及酪氨酸—蛋氨酸—天冬氨酸—天冬氨酸 (YMDD)含量。【结果】叶下珠复方组肝功能复常率、HBeAg转阴率均高于拉米夫定组 ,而HBV DNA转阴率低于拉米夫定组 (P <0 0 5 ) ,YMDD变异少于拉米夫定组 (P <0 0 5 ) ;两药合用组的HBeAg转阴率与叶下珠复方组相仿 (P >0 0 5 )而高于拉米夫定组 (P <0 0 1) ,HBV DNA转阴率均高于叶下珠复方组和拉米夫定组 (均P <0 0 1) ,肝功能复常率高于拉米夫定组 (P <0 0 5或P<0 0 1) ,YMDD变异也少于拉米夫定组 (P <0 0 5 )。【结论】叶下珠复方与拉米夫定联合用药可提高治疗慢性乙型肝炎疗效 ,减少YMDD变异 ,推迟和避免拉米夫定耐药株产生 ,以及由此而引起的病毒在体内的持续复制。

To investigate the therapeutic effect of Phyllanthus compound (PC), lamivudine and the combination of the above two drugs on chronic hepatitis B. Ninety cases of chronic hepatitis B were randomized to three groups: group A (PC 2.6?g, three times a day), group B (lamivudine 100?mg, once a day) and group C (the combination of PC and lamivudine).Oral use of the above drugs was continued for 52 weeks. Heptatic function and serum contents of hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg), hepatitis B virus deoxyribonucleic acid (HBV-DNA) and gene mutation of YMDD (tyrosine-methionine-aspartic acid- aspartic acid) were observed before and after treatment. The recovery rate of hepatic function and HBeAg-turning-negative rate were higher, HBV-DNA-turning-negative rate was lower and YMDD mutation less in group A than those in group B (P<0.05); in group C, HBeAg-turning-negative rate was similar to that in groups A (P>0.05) but higher than that in group B (P<0.01), HBV-DNA-turning-negative rate was higher than that in groups A and B, the recovery rate of hepatic function was higher and YMDD mutation less than those in group B (P<0.05 or P<0.01).[Conclusion]The combination of PC and lamivudine exerts a better effect in treating chronic hepatitis B and is capable of reducing YMDD mutation, delaying the occurrence of lamivudine-resistance virus and continuous in-vivo replication of hepatitis B virus.