【摘要】 目的观察替比夫定治疗高ALT水平HBeAg阳性慢性乙型肝炎(CHB)患者的疗效。方法 60例HBeAg阳性的CHB患者以ALT为依据分为低ALT组(ALT在2倍ULN与10倍之间)和高ALT组(ALT在10倍ULN与20倍之间),给予替比夫定600 mg/d,观察治疗52周时的应答情况。结果治疗52周时,高ALT组HBV DNA降低比例明显高于低ALT组,差异有统计学意义;低ALT组HBeAg阴转率及血清学转换率、HBsAg阴转率低于高ALT组,差异有统计学意义;高ALT组中有4例出现HBsAg阴转,3例出现了HBsAb;低ALT组中没有出现HBsAg阴转及血清学转换。52周时两组患者ALT复常率、病毒学反弹、对替比夫定耐药及肌酸激酶升高水平相似。结论高水平ALT是替比夫定治疗应答较好的预测因子。更多还原

【Abstract】 Objective To evaluate the therapeutic efficacy of telbivudine(LDT) in hepatitis B e antigen(HBeAg)-positive chronic hepatitis B(CHB) patients with high baseline alanine aminotransferase(ALT) levels.Methods A total of 60 HBeAg-positive CHB patients were allocated to the higher baseline ALT group with ALT between 10 and 20 times the upper limit of normal and the lower baseline ALT group with ALT between 2 and 10 times the upper limit of normal according to the ALT level,and all patients were given LDT 600 mg daily as initial antiviral treatment for at least 52 weeks.We compared the response profiles between the two groups at 52 week.Results By week 52,the mean hepatitis B virus(HBV) DNA level decreased significantly in the higher baseline ALT group than the lower baseline ALT group,and there was significant difference;furthermore,there was respectively significant difference in the HBeAg-negativity HBeAg seroconversion,HBsAg-negativity between the two groups;moreover,4 cases became hepatitis B surface antigen(HBsAg)-negative and 3 had HBsAg seroconversion in the higher baseline group.None in the lower baseline group became HBsAg-negative and seroconversion.The ALT normalization rate,viral breakthrough,genotypic resistance to LDT,and elevations in creatine kinase levels were similar in the two groups over the 52 week.Conclusion Higher baseline ALT level is a strong predictor for optimal efficacy with LDT treatment.更多还原