摘要
目的研究拉米夫定联合用药与单一用药治疗慢性乙型肝炎(慢乙肝)的疗效及远期转归,探索拉米夫定联合用药治疗慢乙肝的疗程,寻求更加有效的抗乙肝病毒策略及治疗方法。方法慢乙肝患者140例,ALT均大于2倍正常值上限(211.3±98.4U/L),HBeAg及HBV DNA均阳性。随机分A、B、C三组,经统计学处理各组间差异无显著性。其中A组(对照组)54例,B组(拉米夫定治疗组)52例,C组(拉米夫定联合α-干扰素治疗组)34例。A组不使用抗乙肝病毒(HBV)及免疫调节制剂,予常规护肝治疗。B、C两组均予拉米夫定100mg治疗,1/d,口服,时间一年;两周后,C组加用α-干扰素3MU,1/d肌肉注射,两周后改为隔日一次,6个月后停用α-干扰素。于治疗3、6、12个月时比较疗效,三组治疗前及治疗开始后每月复查肝功、乙肝病毒血清免疫学标志物(HBsAg、抗-HBs、HBeAg、抗-HBe、抗-HBc,RIA法)、HBV DNA等项目,以综合评价疗效。结果治疗开始后3、6、12个月时ALT、HBV DNA变化A组与B、C两组差异均有显著性(P<0.01),B组与C组间差异均无显著性(P>0.05);HBeAg阴转率在治疗3、6、12个月时A组与B、C两组差异均有显著性(P<0.05或P<0.01),12个月时B、C两组间差异有显著性(P<0.05);抗-HBe阳转于治疗3、6、12个月时A组与B组间差异均无显著性(P>0.05),治疗6、12个月时A、B两组与C两组差异均有显著性(P<0.05或P<0.01)。结论拉米夫定治疗慢乙肝,抗病毒作用迅速,表现为生化学完全应答、病毒学完全应答及血清免疫学部分应答与对照组比较差异均有显著性,血清免疫学完全应答与对照组比较差异无显著性。提示拉米夫定抑制HBV及促进肝功能恢复方面疗效较佳。但HBeAg血清转换率明显低于现有资料报道,提示应用拉米夫定的慢乙肝患者都将面临无适当时机停药这一难题。而拉米夫定联合α-干扰素治疗慢性乙型肝炎,可增加血清免疫学的应答率,且两组间差异随治
objective To investigate the short
- term and long - term effects of lamivudine and IFN
- a combination therapy for patients with chronic
hepatitis B (CHB). To probe the period of treat-
ment. To seek the better strategy against hepatitis B
virus (HBV). Methods A total of 140 patients with
CHB whose serum ALT were higher than the two
times of abnormal upper limit value (21l. 3±
98. 4U/L) and whose HBeAg and HBV - DNA were
positive. All the cases were randomized into three
groups: group A, group B or group C. group A (con-
trol groups) contained 54 cases. group B (lamivudine
treatment) contained 52 cases. group C (lamivudine
and IFN - a combination therapy) contained 34 cas-
es. Patients in group A were not treated with
medicine against HBV or medicine of immunoregula-
tion but only protecting liver medicine. Patients in
group B and group C took orally lamivudine 100 mg
once a day, lasting 12 months. Furthermore, pa-
tients of group C accepted IFN - a injection muscle
three million units once a day in first two weeks and
then once two days, lasting six months. Curative ef-
fects were compared in 3, 6 and 12 month respective-
ly. Liver function, markers of HBV in serum (HB-
sAg, anti - HBs, HBeAg, anti - HBe, anti - HBc,
with RIA method) and HBV - DNA were examined
to analysis the synthetic effect. Results Changes of
ALT and HBV - DNA were significantly different be-
tween group A and group C or between group A and
group C (P< 0. 01 ). No significant difference be-
tween group B and group C(P> 0. 05 ). The rate of
HBeAg negative conversion were significantly differ-
ent between group A and group B or between group A
and group C at the 3rd, 6th and 12th month respec-
tively (P< 0. 05 or P<0. 01 ), and were signific
出处
《传染病信息》
2002年第3期128-129,共2页
Infectious Disease Information
