拉米夫定治疗4周检测HBV DNA水平对52周疗效的预测.DOCVIP

临床医学论文-拉米夫定治疗4周检测HBV DNA水平对52周疗效的预测 ????????????????? 作者：杨柳絮 赵中夫 刘明社 马丽娜 王麟　 韩红莉 卢俊敏 常蕴青?? 【摘要】? 　　目的：探讨拉米夫定 (LVD) 治疗4周检测血清HBV DNA水平对远期HBV DNA转阴率、ALT复常率和耐药发生率的预测价值。方法：入组100例YMDD阴性的慢性乙型肝炎患者（CHB），其中HBeAg阳性患者72例，HBeAg阴性患者28例。男70例，女30例。LVD 100 mg/d治疗4周，检测血清HBV DNA水平，将HBV DNA103拷贝/mL患者45例和≥103拷贝/mL 55例分别作为Ⅰ组和Ⅱ组继续观察。治疗52周后,检测血清HBV DNA，ALT，HBV M和YMDD。结果：血清HBV DNA转阴率：Ⅰ组为93.3%，Ⅱ组为43.6%，χ2=27.24，P0.001；ALT复常率：Ⅰ组为95.6%，Ⅱ组为70.9%，χ2=10.186，P=0.001；YMDD变异率：Ⅰ组为0%，Ⅱ组为23.6%， χ2=12.226，P0.001；HBeAg血清转换率：Ⅰ组为55.6%，Ⅱ组为36.3%，χ2=3.683，P=0.055。结论：拉米夫定治疗4周对HBV DNA的抑制程度可预测52周的疗效。 【关键词】? YMDD变异 拉米夫定 阿德福韦酯 慢性乙型肝炎 　　Abstract? Objective：To evaluate the efficacy of 52-week lamivudine treatment by testing hepatitis B virus DNA levels at 4-week. Methods： 100 patients with YMDD-negative chronic hepatitis B were received LVD 100　mg/d for 4 weeks. They were then categorized into 2 groups according to their serum HBV DNA levels (copied/mL): HBV DNA103 (group Ⅰ) and HBV DNA ≥103(group Ⅱ), and the treatment was continued. At week 52, YMDD was tested by mismatched-PCR. HBV DNA levels were measured by quantitative PCR, alanine aminotransferase（ALT）and HBeAg were conducted? according to instructions. Results： Although HBeAg seroconversion of patients occurred in groupⅠwas similar to that in group Ⅱ(55.6% versus 36.3% P0.05)，higher proportions of patients in groupⅠthan that in groupⅡachieved HBV DNA10３ copies/mL(93.3% versus 43.6%,P0.001). Rate of ALT normalization of patients in groupⅠsignificantly increased than that in group Ⅱ(95.6% versus 70.9%, P=0.001),and the YMDD mutation rate was remarkably declined in groupⅠas compared with that of the groupⅡthrough 52 weeks. Conclusion： The measurement of the HBV DNA levels at week 4 of lamivudine treatment should be performed to predict 52-week outcome and YMDD mutation rate.???? 　　Key words? YMDD mutation; Lamivudine; Adefovir dipivoxil; Chronic hepatitis B??? 　　近年来，随着核苷类似物应用于慢性乙型肝炎(CHB)的治疗，CHB的治疗状况有了很大的改善。目前国内已上市的有拉米夫定(LVD)，阿德福韦酯(ADV)，恩替卡韦(ETV)和替比夫定(LdT)，