拉米夫定并干扰素α对HBeAg阳性慢性乙型肝炎效果.docVIP

拉米夫定并干扰素α对HBeAg阳性慢性乙型肝炎效果 　　作者：郭保营,李建忠　　作者单位：青岛大学医学院 　　【摘要】 目的评价拉米夫定(LMD)并干扰素Α(IFNΑ)治疗HBeAg阳性慢性乙型肝炎(CHB)的效果。方法将160例HBVDNA和HBeAg阳性的CHB病人随机分为A、B、C共3组。A组给予LMD 100 mg/d,联用IFNΑ 5 MU,3次/周;B组单用LMD 100 mg/d;C组单用IFNΑ 5 MU，3次/周，3组均12个月为一疗程。3组均在6个月及疗程结束时进行疗效评价。结果 治疗6个月时，A组HBeAg转阴率、HBeAg/抗HBe血清转换率均显著高于B组，差异有显著性(Χ2=9.646、11.332，P0.05); A组丙氨酸氨基转移酶(ALT)复常率显著高于C组，差异有显著性(Χ2=24.158,P0.05)。疗程结束时， A组HBeAg转阴率、HBeAg/抗HBe血清转换率均显著高于B组，差异有显著意义(Χ2=15.684、13.907,P0.05)，A组酪氨酸蛋氨酸天门冬氨酸天门冬氨酸(YMDD)变异率明显低于B组，差异有显著意义(Χ2=5.688，P0.05);A组ALT复常率、HBVDNA转阴率、HBeAg转阴率、HBeAg/抗HBe血清转换率均明显高于C组,差异有显著意义(Χ2=5.649～7.016，P0.05)。结论 LMD联合IFNΑ是HBeAg阳性CHB病人安全而较有效的治疗方法，其YMDD变异率低于单用LMD，疗效明显优于单用LMD或IFNΑ。 　　【关键词】 肝炎,乙型,慢性,拉米夫定,干扰素Α,药物疗法,联合 　　[ABSTRACT] Objective To evaluate the efficacy of lamivudine (LMD) combined with alpha interferon (IFNΑ) on patients with chronic HBeAgpositive hepatitis B (CHB). Methods This study consisted of 160 CHB patients, with both HBVDNA and HBeAg positive, who were randomly divided into groups A, B and C. The patients in group A received IFNΑ 5 MU, three times a week plus LMD 100 mg/d; those in group B received LMD 100 mg/d alone; and those in group C received IFNΑ 5 MU alone, three times a week. The course of treatment lasted for 12 months. The curative effect was assessed six months and upon completion of the trial. Results After six months of therapy, in group A, the negativereturning rate of HBeAg and frequence of seroconversion of HBeAg/antiHBe were significantly higher than those in group B (Χ2=9.646,11.332;P0.05); the normalreturning rate of alanine aminotransferase (ALT) was significantly higher than in group C (Χ2=24.158,P0.05). Upon completion of the course, in group A, the rates of negativereturning of HBeAg and seroconversion of HBeAg/antiHBe were higher, and the tyrosinemethionineaspartateaspartate (TMAA) mutation rates were lower than that in group B (Χ2=5.688,P0.05), the normalreturning rate of ALT, HBVDNA, HBeAg, and frequence of seroconversion o