摘要
目的 观察拉米夫定长期治疗慢性乙型肝炎（CHB）3年以上患者的血清转换率和停药后持久率，及影响疗效的有关因素。方法 167例CHB患者，每天服用拉米夫定100mg，持续3年以上，连续2次以上出现血清转换（间隔3个月），即HBeAg转阴和抗HBe转阳，继续服药6～12个月后，停药并随访1年以上。服药第1年每月，以后第3个月观察临床症状和血清病毒学标志、丙氨酸转氨酶（ALT）、HBV DNA定量及YMDD变异等项目。HBV基因分型应用型特异性PCR方法。结果 共有45例患者出现血清转换（27．0％），继续服药6～12个月后停药并随访1年以上，9例出现血清学重新激活，血清转换持久率为80．0％。经单因素统计和Logistic多元回归分析，得出血清转换率和停药后持久率与基线ALT水平呈正相关，与基线HBVDNA水平和治疗后YMDD变异呈负相关。结论 CHB患者出现血清转换后继续应用拉米夫定治疗6个月以上，大多数患者可达到持续转换。对血清转换率和持久率有显著影响意义的因子为基线ALT、治疗后YMDD变异。
Objective To observe the factors of which may impact the rate of HBeAg seroconversion and its durability after long-term lamivudine therapy in patients with HBeAg positive chronic hepatitis B. Methods 167 patients with HBeAg positive CHB were treated with lamivudine 100 mg daily more than 3 years. Once HBeAg seroconversion occurred more than two times（once every 3 months） ,the patients continued for 6-12 months, then stopped lamivudine and were followed-up for more than 1 year. The clinical, virological and biochemical observation and tests were performed monthly in the first year,then every 3 months. HBV serologic markers, HBV DNA level, alanine aminotransferase （ALT）, and YMDD mutation were tested. HBV genotyping was performed by type-specific PCR. Data were analyzed by Logistic multivariant analysis. Results 45 patients obtained HBeAg sreoconversion（27.0% ）. The annual accumulative seroconversion rates were 10.2%, 16.7% ,23.3% ,25.1%and 27.0% in 1st,2nd,3rd,4th and 5th years,respectively.9 patients developed reactivation with reappearance of HBeAg and elevation of HBV DNA after more than 1 year followed-up. The 1-year durability of HBeAg seroconversion after discontinuing lamivudine therapy was 80.0% .The single and multivariate analysis showed that the rate of HBeAg seroconversion and its durability were positively corrlated with a high baseline ALT,negatively correlated with a high baseline HBV DNA and YMDD mutation. Conclusion Continuation of lamivudine therapy for more than 6 months after HBeAg seroconversion might increase the durability of response.
出处
《肝脏》
2006年第3期158-160,共3页
Chinese Hepatology
关键词
慢性乙型肝炎
拉米夫定
血清转换
Chronic hepatitis B
Lamivudine
HBeAg seroconversion
