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目的:研究合理选择拉米夫定的临床策略。方法:入选2002年9月-2006年8月期间108例慢性HBV感染患者,根据HBeAg情况分为HBeAg(+)组和HBeAg(-)组。两组患者均给予拉米夫定,100mg/d,口服,长期治疗,随访终点至2009年9月。结果:108例患者随访37~84月,平均(58±13.6)月,两组患者的病毒学突破率与HBVDNA阴转速度有关,阴转速度越快,以后发生耐药的机会越低;2周内HBVDNA阴转患者,发生病毒学突破率为0%,临床耐药率为0%,HBeAg血清转换率为62.5%;3～4周内阴转患者,在随访期发生病毒学突破率分为8.3%和11.1%,临床耐药率为0%,HBeAg血清转换率为50%;5~8周、9~12周、13~24周发生阴转患者,随访期间发生病毒学突破率分别为44%~52.6%、75%~80%和100%。结论:2周、4周的病毒学应答能更精确地预测慢性HBV感染患者应用拉米夫定抗病毒治疗的远期疗效和耐药,对临床早期筛查拉米夫定治疗慢性HBV感染患者具有重要的指导意义。
Objective: To study the clinical strategy of rational choice of lamivudine. Methods: One hundred and eighty patients with chronic HBV infection were selected from September 2002 to August 2006, and divided into HBeAg (+) group and HBeAg (-) group according to their HBeAg status. Both groups were given lamivudine, 100mg / d, oral, long-term treatment, the end of follow-up to September 2009. Results: The 108 patients were followed up for 37-84 months with an average of (58 ± 13.6) months. The rate of virological breakthrough in both groups was related to the negative rate of HBVDNA. The faster the negative rate of rotation was, the lower the chance of subsequent drug resistance was. 2 Week HBVDNA negative patients, the virological breakthrough rate of 0%, the clinical resistance rate was 0%, HBeAg seroconversion rate was 62.5%; 3 to 4 weeks of patients with negative conversion rate of virological breakthrough during the follow-up period Were 8.3% and 11.1%, respectively. The rate of clinical drug resistance was 0%, and the rate of HBeAg seroconversion was 50%. The patients with negative conversion occurred at 5-8 weeks, 9-12 weeks and 13-24 weeks. Virological breakthrough rate 44% to 52.6%, 75% to 80% and 100%. Conclusions: The virological response at 2 weeks and 4 weeks can predict the long-term efficacy and drug resistance of patients with chronic HBV infection more accurately by lamivudine antiviral therapy. The early clinical screening of lamivudine in patients with chronic HBV infection It has important guiding significance.