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目的观察拉米夫定治疗慢性乙型肝炎患者5年的血清转换率和持续血清转换率及多元因素对两者的影响。方法81例慢性乙型肝炎患者,每天服用拉米夫定100 mg,持续5年。出现血清转换后, 继续服拉米夫定6个月以上(每3个月随访1次,至少2次以上),仍为乙型肝炎e抗原(-)和抗-HBe(+), 则停药并继续随访6-12个月。所需观察项目有丙氨酸氨基转移酶、血清病毒学标志物、乙型肝炎病毒DNA 载量及基因分型、YMDD变异等。结果(1)共有26例患者出现血清转换。总血清转换率为32.10% (26/81)。第1-5年,每年累积的血清转换率为16.05%、19.75%、27.16%、28.40%和32.10%。(2)停药后4例出现复发,持续血清转换率为84.62%(22/26)。(3)经Logistic多元回归分析,得出近期血清转换率和持续血清转换率与治疗前丙氨酸氨基转移酶水平呈正相关,与治疗前乙型肝炎病毒DNA水平呈负相关。持续血清转换与血清转换后继续服药时间有相关性。结论慢性乙型肝炎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。对持续血清转换的影响因素为治疗前丙氨酸氨基转移酶和乙型肝炎病毒DNA水平(P<0.05)。
Objective To observe the effects of lamivudine on 5 years seroconversion rate and continuous seroconversion rate in patients with chronic hepatitis B and multivariate factors. Methods Eighty-one patients with chronic hepatitis B were treated with lamivudine 100 mg every day for 5 years. After seroconversion, continue lamivudine for more than 6 months (once every 3 months, at least 2 times), still hepatitis B e antigen (-) and anti-HBe (+), stop Drugs and continue for 6-12 months. The required observations of alanine aminotransferase, serum virological markers, hepatitis B virus DNA load and genotyping, YMDD mutation. Results (1) A total of 26 patients had seroconversion. The total seroconversion rate was 32.10% (26/81). During the first 1-5 years, the annual cumulative seroconversion rates were 16.05%, 19.75%, 27.16%, 28.40% and 32.10%. (2) Four cases relapsed after discontinuation, and the continuous seroconversion rate was 84.62% (22/26). (3) Logistic multivariate regression analysis showed that the recent seroconversion rate and continuous seroconversion rate were positively correlated with the level of alanine aminotransferase before treatment, and negatively correlated with the level of hepatitis B virus DNA before treatment. Continued seroconversion was associated with continued medication after seroconversion. Conclusion In patients with chronic hepatitis B, lamivudine treatment continues for more than 6 months after seroconversion, and most patients can achieve continuous conversion. The influencing factors for continuous seroconversion were alanine aminotransferase and hepatitis B virus DNA levels before treatment (P <0.05).