【摘要】 目的:了解拉米夫定治疗早期血清丙氨酸氨基转移酶(ALT)的变化特点及其临床意义。方法:符合条件接受拉米夫定治疗的慢性乙型肝炎患者进入研究,早期ALT升高定义为治疗前4周HBV DNA下降而ALT较基线升高。结果:所有158例患者在治疗第4周HBV DNA均较基线下降,31.6%(50/158)患者ALT水平较基线升高。与ALT持续下降组比较,早期ALT升高组患者累积ALT正常化比例低(96.3%vs86.0%,P=0.035),ALT首次正常发生时间晚(治疗后平均14周vs23周,P<0.001);HBeAg阳性患者的HBeAg转阴率较低(23/89vs5/46,P=0.023),但转阴发生时间差别不明显(P=0.097);发生HBV临床耐药的比例差异无统计学意义(17.6%vs32.0%,P=0.063)。基线HBVDNA负荷高和ALT水平低是发生治疗早期ALT升高的危险因素。结论:拉米夫定治疗早期ALT升高是常见临床现象,总的来讲不是良性临床事件。更多还原

【Abstract】 Objective To explore the early change of alanine aminotransferase (ALT) during lamivudine therapy and its clinical significance. Methods The patients with chronic hepatitis B who were candidates to receive lamivudine therapy were enrolled in this study. Early ALT elevation (EAE) was defined as ALT level at week 4 higher than the baseline with a reduced HBV DNA viral load (vDNA). Results On week 4,HBV vDNA was decreased in all the patients while ALT was elevated in 50 patients (31.6%). As compared with those with a continuous decline in ALT,the patients with EAE had a lower cumulative ratio of ALT normalization (86.0% vs 96.3%,P=0.035),late initial ALT normalization after treatment (23 weeks vs 14 weeks,P<0.001),and a lower accumulative ratio of HBeAg loss (23/89 vs 5/46,P=0.023). However,the time to HBeAg loss and the cumulative occurrence of clinical lamivudine resistance did not differ significantly (P=0.097; 17.6% vs 32.0%,P=0.063). A higher HBV vDNA and lower ALT level at baseline were risk factors for EAE. Conclusion Early ALT elevation is common during lamivudine therapy,which seems not to be a positive event.更多还原