CAJ | 학술논문

目的评价拉米夫定(LAM)治疗e抗原阴性慢性乙型肝炎患者治疗前基线ALT、HBsAg、HBV DNA水平以及治疗4周和12周时HBV DNA<1×10~3拷贝/ml对其治疗104周时抗HBV疗效的预测价值. 方法 127例成年e抗原阴性慢性乙型肝炎患者均接受LAM 100 mg/d治疗,且均完成≥104周的治疗.治疗期间定期复查肝功能、HBV标志物(HBsAg、抗-HBs,HBeAg、抗-HBe、抗-HBc)及HBV DNA水平.分别比较和分析不同基线ALT、HBsAg、HBV DNA水平及治疗4周和12周时不同HBV DNA水平与治疗104周时疗效的关系.数据采用x~2检验及多元逐步Logistic回归分析.结果基线ALT<5×正常值上限(ULN)和ALT≥5×ULN两组患者,治疗104周血清HBV DNA<1×10~3拷贝/ml的比例分别为50.0%和86.8%(P<0.01).基线HBsAg<2000 COI和HBsAg≥2000 COI两组患者,治疗104周时HBsAg<500 COI的比例分别为19.1%和17.5%(P>0.05);HBsAg/抗-HBS血清学转换率分别为2.1%和2.5%(P>0.05),血清HBV DNA<1×10~3拷贝/ml的比例分别为61.7%和67.5%(P>0.05).基线HBV DNA<1×10~6拷贝/ml和HBV DNA≥1×10~6拷贝/ml两组患者,至治疗4周和12周时HBV DNA<1×10~3拷贝/ml的比例差异均有统计学意义(P值均<0.01),但至治疗104周时HBV DNA<1×10~3拷贝/ml的比例分别为62.7%和67.1%,差异无统计学意义(P>0.05).治疗4周时HBVDNA<1×10~3拷贝/ml和HBV DNA≥1×10~3拷贝/ml两组患者,104周时HBV DNA<1×10~3拷贝/ml的比例分别为70.7%和60.9%(P>0.05);治疗12周时HBV DNA<1×10~3拷贝/ml和HBV DNA≥1×10~3拷贝/ml两组患者,104周时HBV DNA<1×10~3拷贝/ml的比例分别为78.8%和38.1%(P<0.01).结论基线ALT≥5×ULN和治疗12周HBV DNA<1×10~3拷贝/ml的e抗原阴性慢性乙型肝炎患者用LAM继续治疗至104周时可以取得较好的病毒学应答.治疗前不同基线HBsAg水平对治疗104周时HBsAg的水平、HBsAg/抗-HBs血清学转换率和HBV载量的预测价值不大;基线HBV DNA水平对104周时是否获得病毒学应答的预测价值也不大. 目的評價拉米伕定(LAM)治療e抗原陰性慢性乙型肝炎患者治療前基線ALT、HBsAg、HBV DNA水平以及治療4週和12週時HBV DNA<1×10~3拷貝/ml對其治療104週時抗HBV療效的預測價值. 方法 127例成年e抗原陰性慢性乙型肝炎患者均接受LAM 100 mg/d治療,且均完成≥104週的治療.治療期間定期複查肝功能、HBV標誌物(HBsAg、抗-HBs,HBeAg、抗-HBe、抗-HBc)及HBV DNA水平.分彆比較和分析不同基線ALT、HBsAg、HBV DNA水平及治療4週和12週時不同HBV DNA水平與治療104週時療效的關繫.數據採用x~2檢驗及多元逐步Logistic迴歸分析.結果基線ALT<5×正常值上限(ULN)和ALT≥5×ULN兩組患者,治療104週血清HBV DNA<1×10~3拷貝/ml的比例分彆為50.0%和86.8%(P<0.01).基線HBsAg<2000 COI和HBsAg≥2000 COI兩組患者,治療104週時HBsAg<500 COI的比例分彆為19.1%和17.5%(P>0.05);HBsAg/抗-HBS血清學轉換率分彆為2.1%和2.5%(P>0.05),血清HBV DNA<1×10~3拷貝/ml的比例分彆為61.7%和67.5%(P>0.05).基線HBV DNA<1×10~6拷貝/ml和HBV DNA≥1×10~6拷貝/ml兩組患者,至治療4週和12週時HBV DNA<1×10~3拷貝/ml的比例差異均有統計學意義(P值均<0.01),但至治療104週時HBV DNA<1×10~3拷貝/ml的比例分彆為62.7%和67.1%,差異無統計學意義(P>0.05).治療4週時HBVDNA<1×10~3拷貝/ml和HBV DNA≥1×10~3拷貝/ml兩組患者,104週時HBV DNA<1×10~3拷貝/ml的比例分彆為70.7%和60.9%(P>0.05);治療12週時HBV DNA<1×10~3拷貝/ml和HBV DNA≥1×10~3拷貝/ml兩組患者,104週時HBV DNA<1×10~3拷貝/ml的比例分彆為78.8%和38.1%(P<0.01).結論基線ALT≥5×ULN和治療12週HBV DNA<1×10~3拷貝/ml的e抗原陰性慢性乙型肝炎患者用LAM繼續治療至104週時可以取得較好的病毒學應答.治療前不同基線HBsAg水平對治療104週時HBsAg的水平、HBsAg/抗-HBs血清學轉換率和HBV載量的預測價值不大;基線HBV DNA水平對104週時是否穫得病毒學應答的預測價值也不大.
목적 평개랍미부정(LAM)치료e항원음성만성을형간염환자치료전기선ALT、HBsAg、HBV DNA수평이급치료4주화12주시HBV DNA<1×10~3고패/ml대기치료104주시항HBV료효적예측개치. 방법 127례성년e항원음성만성을형간염환자균접수LAM 100 mg/d치료,차균완성≥104주적치료.치료기간정기복사간공능、HBV표지물(HBsAg、항-HBs,HBeAg、항-HBe、항-HBc)급HBV DNA수평.분별비교화분석불동기선ALT、HBsAg、HBV DNA수평급치료4주화12주시불동HBV DNA수평여치료104주시료효적관계.수거채용x~2검험급다원축보Logistic회귀분석.결과 기선ALT<5×정상치상한(ULN)화ALT≥5×ULN량조환자,치료104주혈청HBV DNA<1×10~3고패/ml적비례분별위50.0%화86.8%(P<0.01).기선HBsAg<2000 COI화HBsAg≥2000 COI량조환자,치료104주시HBsAg<500 COI적비례분별위19.1%화17.5%(P>0.05);HBsAg/항-HBS혈청학전환솔분별위2.1%화2.5%(P>0.05),혈청HBV DNA<1×10~3고패/ml적비례분별위61.7%화67.5%(P>0.05).기선HBV DNA<1×10~6고패/ml화HBV DNA≥1×10~6고패/ml량조환자,지치료4주화12주시HBV DNA<1×10~3고패/ml적비례차이균유통계학의의(P치균<0.01),단지치료104주시HBV DNA<1×10~3고패/ml적비례분별위62.7%화67.1%,차이무통계학의의(P>0.05).치료4주시HBVDNA<1×10~3고패/ml화HBV DNA≥1×10~3고패/ml량조환자,104주시HBV DNA<1×10~3고패/ml적비례분별위70.7%화60.9%(P>0.05);치료12주시HBV DNA<1×10~3고패/ml화HBV DNA≥1×10~3고패/ml량조환자,104주시HBV DNA<1×10~3고패/ml적비례분별위78.8%화38.1%(P<0.01).결론 기선ALT≥5×ULN화치료12주HBV DNA<1×10~3고패/ml적e항원음성만성을형간염환자용LAM계속치료지104주시가이취득교호적병독학응답.치료전불동기선HBsAg수평대치료104주시HBsAg적수평、HBsAg/항-HBs혈청학전환솔화HBV재량적예측개치불대;기선HBV DNA수평대104주시시부획득병독학응답적예측개치야불대.
Objective To evaluate the effects of ALT, HBsAg and HBV DNA at the baseline, 4and 12 weeks after lamivudine treatment on the long term (104 weeks) response in e antigen-negative chronic hepatitis B patients. Methods 127 adult e antigen-negative chronic hepatitis B patients were enrolled in this study. All patients received treatment on LAM 100 mg/d for at least 104 weeks. The liver function, serum HBV markers and HBV viral load were regularly checked during the treatment. The effects of ALT, HBsAg and HBV DNA at the baseline, 4 and 12 weeks after lamivudine treatment on the response at 104 weeks were statitistically analyzed. Results The proportion of patients with serum HBV DNA <10~3 copies / ml at 104 weeks after LAM treatment was 50.0% and 86.8% in patients with baseline ALT< 5 ULN and ALT≥5 ULN, respectively (P<0.01). In patients with baseline HBsAg <2000 COI and HBsAg≥2000 COI, the propor-tion of patients with serum HBsAg < 500 COI at 104 weeks after LAM treatment was 19.1% and 17.5%, respectively (P>0.05). The HBsAg serological conversion rates were respectively 2.1% and 2.5%, respec-tively (P>0.05), the proportion of patients with serum HBV DNA <1×10~3 copies/ml was 61.7% and 67.5%, respectively (P>0.05). In patients with baseline HBV DNA <10~6 copies/ml and HBV DNA≥1×10~6 copies/ml, the proportion of patients with HBV DNA<103 copies/ml were statistically different at 4 weeks and 12 weeks after treatment, however, the proportion of patients with HBV DNA <1×10~3 copies/nil at 104 weeks after LAM treatment was 62.7% and 67.1%, respectively (P>0.05). In patients with HBV DNA <1× 10~3 copies/nil and HBV DNA≥1×10~3 copies/ml at 4 weeks after treatment, the proportion of patients with HBV DNA <1×10~3 copies/ml at 104 weeks after LAM treatment was 70.7% and 60.9%, respectively (P> 0.05). In patients with HBV DNA <10~3 copies/nil and HBV DNA≥1×10~3 copies/ml at 12 weeks after treatment, the proportion of patients with HBV DNA <10~3 copies/ml at 104 weeks after treatment was 78.8% and 38.1%, respectively (P<0.01). Conclusion e antigen negative chronic hepatitis B patients with baseline ALT ≥ 5 ULN and HBV DNA <1×10~3 copies/ml at 12 weeks after treatment have better virological response at 104 weeks after LAM treatment. The baseline HBsAg and HBV DNA load are associated with the virological response at 104 weeks after LAM treatment.