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目的观察拉米夫定治疗发生乙型肝炎e抗原(HBeAg)／抗-HBe血清转换的慢性乙型肝炎患者的转归。方法对发生HBeAg／抗-HBe血清转换时间≥6个月、拉米夫定治疗疗程≥18个月的68例患者进行24个月以上的随访观察。结果拉米夫定治疗后HBeAg／抗HBe血清转换率为25.19％,YMDD变异率为20.59％,HBeAg／抗-HBe血清转换后随访期内复发率为27.94％,停药后复发者再服拉米夫定有效。复发与年龄、治疗前丙氨酸氨基转移酶水平有关,与治疗前HBVDNA水平、疗程及有无YMDD变异无关。结论拉米夫定治疗慢性乙型肝炎即使HBeAg／抗-HBe血清转换≥6个月仍有较高的复发率,对长期接受拉米夫定治疗的患者应加强随访观察。
Objective To observe the outcome of lamivudine treatment of patients with chronic hepatitis B who have hepatitis B e antigen (HBeAg) / anti-HBe seroconversion. Methods Sixty-eight patients with HBeAg / anti-HBe seroconversion ≥6 months and lamivudine ≥18 months were followed up for more than 24 months. Results After lamivudine treatment, the seroconversion rate of HBeAg / anti-HBe was 25.19% and the mutation rate of YMDD was 20.59%. The recurrence rate of HBeAg / anti-HBe during the follow-up period was 27.94% Mifidine effective. Relapse and age, before treatment, alanine aminotransferase levels, and before treatment HBVDNA levels, treatment and whether YMDD mutation has nothing to do. Conclusions The lamivudine treatment of chronic hepatitis B has a high relapse rate even if the HBeAg / anti-HBe seroconversion ≥ 6 months, and should be followed up for patients receiving long-term lamivudine therapy.