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目的观察拉米夫定长期治疗慢性乙型肝炎时HBeAg/抗-HBe血清转换和持续血清转换及多元因素对疗效的影响。方法随机选择290例HBeAg阳性的慢性乙型肝炎患者接受正规拉米夫定治疗疗程超过18个月以上,平均疗程为(25.67±7.42)月,所有患者治疗期间每3个月检测HBV-DNA、HBV标志物、肝功能。结果53例发生HBeAg/抗-HBe血清转换,血清转换率为18.62%(53/290),转换发生时间是服药6个月内10例(18.86%)、6个月到12个月14例(26.41%)、超过12个月29例(54.47%)。53例患者中发生YMDD变异10例,发生率为18.86%(10/53),治疗前ALT水平与持续血清转换率呈正相关,与HBV-DNA水平呈负相关。结论拉米夫定长期治疗慢性乙型肝炎能有效地抑制HBV的复制,长期治疗有利于提高HBeAg/抗-HBe血清转换率,有利于病情稳定与肝组织病理学的改善,但有部分患者复发。
Objective To observe the long-term treatment of chronic hepatitis B lamivudine HBeAg / anti-HBe seroconversion and continuous serum conversion and multivariate factors on the effect. Methods A total of 290 patients with HBeAg-positive chronic hepatitis B were randomized to receive lamivudine for more than 18 months. The mean course of treatment was (25.67 ± 7.42) months. All patients were tested HBV-DNA every 3 months, HBV markers, liver function. Results The seroconversion rate of HBeAg / anti-HBe in 53 patients was 18.62% (53/290). The time of conversion was 10 cases (18.86%) in 6 months and 14 cases in 6 months to 12 months 26.41%), 29 cases (54.47%) over 12 months. Among the 53 patients, 10 cases occurred YMDD mutation, the incidence rate was 18.86% (10/53). Before treatment, ALT level was positively correlated with continuous serum conversion rate and negatively correlated with HBV-DNA level. Conclusion Long-term treatment of chronic hepatitis B with lamivudine can effectively inhibit the replication of HBV. Long-term treatment is beneficial to improve the seroconversion rate of HBeAg / anti-HBe, which is beneficial to the stabilization of the disease and the improvement of hepatic histopathology. However, some patients relapse .