拉米夫定联合疗肝3号对乙型肝炎病毒YMDD变异的影响及机制分析.DOCVIP

临床医学论文-拉米夫定联合疗肝3号对乙型肝炎病毒YMDD变异的影响及机制分析 ???????????? 作者：涂燕云，张红星，陈枝俏，蒋阳昆，林海 【摘要】? 　　目的 观察拉米夫定联合疗肝3号对乙型肝炎病毒YMDD变异的影响。方法 将80例慢性乙型肝炎(CHB)患者随机分为治疗组和对照组，治疗组40例为联合应用拉米夫定和疗肝3号；对照组40例为单用拉米夫定，疗程均为18个月，每3个月分别检测肝功能、乙型肝炎病毒血清学标志物、HBV DNA、YMDD变异株、T淋巴细胞亚群。结果 在治疗12个月时，治疗组出现2例（5.00％）变异，对照组5例（12.50％），差异无显著性（P＞0.05）；在治疗18个月时，治疗组出现4例（10.00％）变异，对照组12例（30.00％），差异有显著性（P＜0.05)。停药6个月后治疗组在HBV-DNA阴转、HBeAg/抗-HBe血清转换、HBeAg阴转上明显优于对照组（P均＜0.05)。治疗组外周血CD4+亚群水平上调，CD4+/CD8+比值趋于正常，停药6个月后仍持续保持高水平，与对照组比较差异有高度显著性（P均＜0.01）。结论 拉米夫定联合疗肝3号有调节CHB患者细胞免疫水平的作用，可减少YMDD变异的发生。 【关键词】? 肝炎 乙型 慢性 基因变异 拉米夫定 疗肝3号 　　Abstract:? Objective? To observe the effects of traditional Chinese medicine Liaogansanhao in combination with lamivudine in treatment of patients with chronic hepatitis B (CHB) and its effects on YMDD variants.?Methods?80 patients were enrolled and randomized into two groups: the treated group of 40 cases, treated with Liaogansanhao in combination with lamivudine; the control group of 40 cases, treated with lamivudine alone. One cycle lasted for 18 months, every 3 months, the liver function, virological markers of HBV, serum HBV DNA, YMDD variants and T-cell subpopulation were determined.?Results?At the end of 12-month treatment, 2 cases (5.00%) in the treated group and 5 cases (12.50%) in the control group with YMDD variants were observed, there was no statistical difference (P0.05). At the end of 18-month treatment, 4 cases (10.00%) with YMDD variants were observed in the treated grup and was significantly less than the control group, 12 cases (30.00%), P0.05.?Six months after treatment, HBV-DNA-negative rate, HbeAg/anti-HBe negative and HBeAg negative rate in the treated group were superior to the control group (all P0.01). In the treated group, the CD4+ level was up-regulated and?the ratio of CD4+/CD8+ tended to be in a normal level, and 6 months after the treatment the level remained in a high level, and was significantly higher than the control group (all P0.01).?Conclusion?Liaogansanhao in combina