摘要
目的:观察拉米夫定单药及聚乙二醇α-2a干扰素序贯治疗HBeAg阳性慢性乙型病毒性肝炎(CHB)患者的疗效及安全性。方法:将32例HBeAg和HBV-DNA均阳性的慢性乙型肝炎患者随机分为治疗组和对照组各16例,治疗组口服拉米夫定100mg,1次/日,12个月后,同时给予α-2a干扰素180μg,皮下注射,1次/周,治疗2个月后,停用拉米夫定,继续单独使用干扰素12个月;对照组单用拉米夫定100mg,1次/日口服,疗程26个月。两组治疗结束时及停药6个月检查肝功能、血常规、HBV标志物及HBV-DNA等指标变化,并观察有无不良反应。结果:治疗结束时ALT复常率治疗组和对照组分别为89.5%和86.8%,两组差异无统计学意义(P>0.05),但随访6个月时ALT复常率治疗组和对照组分别为81.6%和55.3%,两组相比差异有统计学意义(P<0.05);治疗组治疗结束时及随访6个月时HBeAg阴转率分别为43.8%和50.0%,对照组分别为25.0%和18.8%(P<0.01);HBeAg转换率治疗组治疗结束时及随访6个月时分别为31.3%和37.5%,对照组分别为18.8%和18.8%(P<0.01);HBsAg转换率治疗组治疗结束时及随访6个月时分别为6.0%和6.0%,对照组分别为0和0(P<0.01);治疗结束时HBV-DNA阴转率治疗组和对照组分别为87.5%和81.2%,两组差异无统计学意义(P>0.05),但随访6个月时治疗组和对照组分别为75.0%和43.8%(P<0.05)。结论:拉米夫定与干扰素序贯治疗慢性乙型肝炎能明显提高抗病毒疗效,持续应答优于单用拉米夫定治疗者。
Objective:To observe the safety and efficacy using cLamivudine monotherapy and polyethylene glycol interferon a-2a sequential treatment on chronic hepatitis B(CHB)patients with HBeAg-positive.Methods:32cases of HBeAg and hbv-dna positive patients with chronic hepatitis B were randomly divided into treatment group and control group,each group have 16 cases,the treatment group received oral lamivudine 100 mg once a day,12 months later,give interferon alpha 2a 180 ug at the same time, subcutaneous injection for once a week,After treat for two months,discontinuation the use of lamivudine,and continue to use interferon for another 12 months;Control group take lamivudine 100 mg oral for once a day,26 months a course.Detection liver function,blood routine,HBV markers and hbv-dna and index change,and observe without adverse reaction for patients in both of the groups at the end of the treatment and drug withdrawal 6 months.Results:At the end of the treatment rate of ALT normalization were 89.5% and 86.8% in treatment group and control group respectively,there was no statistically significant difference(P>0.05) between those two groups,but in 6 months withdrawal rate of ALT normalization were 81.6% and 55.3% in treatment group and control group respectively,there was significant difference between two of the groups(P<0.05);At the end of the treatment and 6 months followed up,the treatment group HBeAg negative transfer rate were 43.8% and 50.0% respectively,and the control group were 25.0% and 18.8% respectively(P<0.01);HBeAg conversion rate at the end of the treatment group and 6 months followed up were 31.3% and 37.5% respectively,and the control group were 18.8% and 18.8% respectively(P<0.01);HBsAg conversion rate at the end of the treatment group and 6 months followed up were 6.0% and 6.0% respectively,and the control group were 0.0% and 0.0% respectively(P<0.01);At the end of the treatment of HBV-DNA conversion rate of treatment group and control group were 87.5% and 81.2% respectively,two groups have no statistical s
