【摘要】 目的分析慢性乙型肝炎(CHB)患者使用拉米夫定(LMD)抗病毒治疗后出现快速病毒学应答(RVR)对一年乙型肝炎病毒脱氧核糖核酸(HBV DNA)转阴率、乙肝病毒e抗原(HBeAg)血清转换率、丙氨酸转氨酶(ALT)复常率和耐药发生率的预测价值,探讨临床实用的疗效预测指标。方法70例HBeAg阳性患者服用LMD抗病毒治疗4周时定量检测HBV DNA,将HBVDNA<3log10cp/ml患者18例和HBV DNA≥3log10cp/ml患者52例作为Ⅰ组和Ⅱ组分层观察,治疗52周时,检测血清HBVDNA,ALT,HBV血清标志物和HBV多聚酶氨基酸序列酪氨酸-蛋氨酸-天门冬氨酸-天门冬氨酸(YMDD)变异。结果治疗52周时的血清HBV DNA转阴率:Ⅰ组为88.9%,Ⅱ组为44.2%;HBeAg血清转换率:Ⅰ组为44.4%,Ⅱ组为11.5%;YMDD变异率:Ⅰ组为0,Ⅱ组为21.2%;ALT复常率:Ⅰ组为94.4%,Ⅱ组为76.9%。经统计学分析,HBV DNA转阴率、HBeAg血清转换率、YMDD变异率两组之间有显著差别。结论LMD治疗4周时出现RVR可预测一年疗效,并且有可能更好的指导临床医生合理使用核苷类似物治疗CHB。更多还原

【Abstract】 Aim To analyze lamivudine effect on patients with chronic hepatitis B who show a rapid virology response.Methods Real-time PCR was used for detecting contents of HBV DNA when 70 patients take lamivudine for 4 weeks,then 18 patients whose HBV DNA <3log10cp/ml were assigned group Ⅰ,52 patients whose HBV DNA ≥ 3log10cp/ml were assigned group Ⅱ.After a treatment of 52 weeks,detection was made for contents of HBV DNA,ALT,serum marker and YMDD mutation.Result After 52 weeks,trans-negative ratios of HBV DNA in group Ⅰ and group Ⅱ were 88.9%,respectively,HBeAg seroconversion rates in group Ⅰ 44.4%,group Ⅱ 11.5%,YMDD mutation rates in group Ⅰ 0%,group Ⅱ 21.2%,ALT recovery rates in group Ⅰ 94.4%,group Ⅱ 76.9%.There was significant difference between the two groups in the trans-negative ratios of HBV DNA,HBeAg seroconversion rates and YMDD mutation rates.Conclusion We can predict efficacy of the year after four weeks of lamivudine treatment of patients with chronic hepatitis B who show a rapid virology response,and it is helpful for rational use of nucleoside analogues.更多还原