中华肝脏病杂志
中華肝髒病雜誌
중화간장병잡지
CHINESE JOURNAL OF HEPATOLOGY
2009年
8期
564-568
,共5页
周华坚%李韶光%温帆渊%杨小云%吴静黎%谭斌%符娟
週華堅%李韶光%溫帆淵%楊小雲%吳靜黎%譚斌%符娟
주화견%리소광%온범연%양소운%오정려%담빈%부연
肝炎%乙型%慢性%拉米夫定%治疗结果%影响因素
肝炎%乙型%慢性%拉米伕定%治療結果%影響因素
간염%을형%만성%랍미부정%치료결과%영향인소
Hepatitis B%chronic%Lamivudine%Treatment outcome%Impact factors
目的 探讨拉米夫定治疗慢性乙型肝炎患者的疗效影响因素,并初步评价基线特征、24周早期病毒学应答及治疗方案对疗效和病毒学突破(VB)发生率的影响.方法 对接受拉米夫定治疗的233例慢性乙型肝炎患者(其中90例治疗期间加用或换用阿德福韦酯)的专科门诊病历资料进行回顾性分析,采用聚合酶链反应法、酶联免疫吸附法分别检测HBV DNA水平与HBsAg、抗-HBs,HBeAg,抗-HBe水平.用SPSS17.0统计软件通过Kaplan-Meier法描述生存时间分布,并分析基线HBV DNA水平,HBeAg状态、ALT水平和疗效的关系.计量资料用t检验分析,计数资料用x2检验.结果 HBeAg阳性与HBeAg阴性患者HBV DNA阴转率分别为63.4%和84.6%,ALT复常率分别为83.8%和81.3%,VB发生率分别为31.0%和14.3%;60.6%的HBeAg阳性患者出现HBeAg阴转,28.9%出现HBeAg/抗-HBe血清学转换.HBeAg阳性患者中,与基线ALT<2.5×正常值上限(ULN)者比较,≥2.5×ULN者HBV DNA阴转率无明显变化(P>0.05),而HBeAg阴转率(66.7%与45.0%)和HBeAg血清学转换率(33.3%与17.5%)明显升高(P值均<0.05),VB发生率则明显下降(34.3%与50.0%,P<0.05),基线HBV DNA<1×106拷贝/ml者VB发生率为23.4%,与HBV DNA≥1×106拷贝/ml者的46.3%比较,差异有统计学意义(P<0.05).HBeAg阳性患者24周有初始病毒学应答(IVR)者的HBV DNA阴转率(76.3%与45.5%)、HBeAg阴转率(72.4%与43.9%)和HBeAg血清学转换率(40.8%与12.1%)均明显高于无IVR者(P值均<0.01),VB发生率较低(28.9%与45.5%,P<0.05).出现VB后,与单一拉米夫定组比较,加药或换药组中HBeAg阳性者HBV DNA阴转率(40.6%与16.7%)、HBeAg血清学转换率(21.9%与0)较高,HBeAg阴转率(37.5%与41.7%)较低,ALT复常率无差别(均为75%);而HBeAg阴性患者的HBV DNA阴转率、ALT复常率较高.结论 拉米夫定抗病毒疗效确切,基线ALT≥2.5×ULN和(或)HBV DNA水平<1×106拷贝/ml的患者疗效较好,VB发生率较低,24周IVR对拉米夫定疗效有预测价值;出现VB后,加用或者换用阿德福韦酯比继续单用拉米夫定治疗的效果好.
目的 探討拉米伕定治療慢性乙型肝炎患者的療效影響因素,併初步評價基線特徵、24週早期病毒學應答及治療方案對療效和病毒學突破(VB)髮生率的影響.方法 對接受拉米伕定治療的233例慢性乙型肝炎患者(其中90例治療期間加用或換用阿德福韋酯)的專科門診病歷資料進行迴顧性分析,採用聚閤酶鏈反應法、酶聯免疫吸附法分彆檢測HBV DNA水平與HBsAg、抗-HBs,HBeAg,抗-HBe水平.用SPSS17.0統計軟件通過Kaplan-Meier法描述生存時間分佈,併分析基線HBV DNA水平,HBeAg狀態、ALT水平和療效的關繫.計量資料用t檢驗分析,計數資料用x2檢驗.結果 HBeAg暘性與HBeAg陰性患者HBV DNA陰轉率分彆為63.4%和84.6%,ALT複常率分彆為83.8%和81.3%,VB髮生率分彆為31.0%和14.3%;60.6%的HBeAg暘性患者齣現HBeAg陰轉,28.9%齣現HBeAg/抗-HBe血清學轉換.HBeAg暘性患者中,與基線ALT<2.5×正常值上限(ULN)者比較,≥2.5×ULN者HBV DNA陰轉率無明顯變化(P>0.05),而HBeAg陰轉率(66.7%與45.0%)和HBeAg血清學轉換率(33.3%與17.5%)明顯升高(P值均<0.05),VB髮生率則明顯下降(34.3%與50.0%,P<0.05),基線HBV DNA<1×106拷貝/ml者VB髮生率為23.4%,與HBV DNA≥1×106拷貝/ml者的46.3%比較,差異有統計學意義(P<0.05).HBeAg暘性患者24週有初始病毒學應答(IVR)者的HBV DNA陰轉率(76.3%與45.5%)、HBeAg陰轉率(72.4%與43.9%)和HBeAg血清學轉換率(40.8%與12.1%)均明顯高于無IVR者(P值均<0.01),VB髮生率較低(28.9%與45.5%,P<0.05).齣現VB後,與單一拉米伕定組比較,加藥或換藥組中HBeAg暘性者HBV DNA陰轉率(40.6%與16.7%)、HBeAg血清學轉換率(21.9%與0)較高,HBeAg陰轉率(37.5%與41.7%)較低,ALT複常率無差彆(均為75%);而HBeAg陰性患者的HBV DNA陰轉率、ALT複常率較高.結論 拉米伕定抗病毒療效確切,基線ALT≥2.5×ULN和(或)HBV DNA水平<1×106拷貝/ml的患者療效較好,VB髮生率較低,24週IVR對拉米伕定療效有預測價值;齣現VB後,加用或者換用阿德福韋酯比繼續單用拉米伕定治療的效果好.
목적 탐토랍미부정치료만성을형간염환자적료효영향인소,병초보평개기선특정、24주조기병독학응답급치료방안대료효화병독학돌파(VB)발생솔적영향.방법 대접수랍미부정치료적233례만성을형간염환자(기중90례치료기간가용혹환용아덕복위지)적전과문진병력자료진행회고성분석,채용취합매련반응법、매련면역흡부법분별검측HBV DNA수평여HBsAg、항-HBs,HBeAg,항-HBe수평.용SPSS17.0통계연건통과Kaplan-Meier법묘술생존시간분포,병분석기선HBV DNA수평,HBeAg상태、ALT수평화료효적관계.계량자료용t검험분석,계수자료용x2검험.결과 HBeAg양성여HBeAg음성환자HBV DNA음전솔분별위63.4%화84.6%,ALT복상솔분별위83.8%화81.3%,VB발생솔분별위31.0%화14.3%;60.6%적HBeAg양성환자출현HBeAg음전,28.9%출현HBeAg/항-HBe혈청학전환.HBeAg양성환자중,여기선ALT<2.5×정상치상한(ULN)자비교,≥2.5×ULN자HBV DNA음전솔무명현변화(P>0.05),이HBeAg음전솔(66.7%여45.0%)화HBeAg혈청학전환솔(33.3%여17.5%)명현승고(P치균<0.05),VB발생솔칙명현하강(34.3%여50.0%,P<0.05),기선HBV DNA<1×106고패/ml자VB발생솔위23.4%,여HBV DNA≥1×106고패/ml자적46.3%비교,차이유통계학의의(P<0.05).HBeAg양성환자24주유초시병독학응답(IVR)자적HBV DNA음전솔(76.3%여45.5%)、HBeAg음전솔(72.4%여43.9%)화HBeAg혈청학전환솔(40.8%여12.1%)균명현고우무IVR자(P치균<0.01),VB발생솔교저(28.9%여45.5%,P<0.05).출현VB후,여단일랍미부정조비교,가약혹환약조중HBeAg양성자HBV DNA음전솔(40.6%여16.7%)、HBeAg혈청학전환솔(21.9%여0)교고,HBeAg음전솔(37.5%여41.7%)교저,ALT복상솔무차별(균위75%);이HBeAg음성환자적HBV DNA음전솔、ALT복상솔교고.결론 랍미부정항병독료효학절,기선ALT≥2.5×ULN화(혹)HBV DNA수평<1×106고패/ml적환자료효교호,VB발생솔교저,24주IVR대랍미부정료효유예측개치;출현VB후,가용혹자환용아덕복위지비계속단용랍미부정치료적효과호.
Objective To identify factors associated with response to lamivudine in chronic hepatitis B patients.Methods Clinical data of 233 chronic hepatitis B patients treated with lamivudine 100 mg daily (91 patients were switched to Adefovir 10mg daily or Adefovir 10mg in combination with lamivudine 100 mg daily) were retrospected.HBV DNA level and serum HBV markers were detected by polymerase chain reaction and enzyme-linked immunosorbent assay.Kaplan-Meier,long-rank,t test were conducted to evaluate the data.Results (1) The rates of HBV DNA loss,ALT normalization,viral breakthrough(VB),HBeAg loss and seroconversion were 63.4%,83.8%,30.9%,30.9%,and 14.3%,respectively,in HBeAg(+) patients;and these were 84.6%,81.3%,14.3%,respectively in HBeAg(-) patients.(2) The rates of HBV DNA loss,HBeAg loss,HBeAg seroconversion,viral breakthrough (VB) were 55% and 66.7% (P>0.05),55.0%,and 66.7% (P<0.05),17.5% and 33.3% (P<0.05),50% and 34.3% (P<0.05) in HBeAg(+) patients with baseline ALT<2.5 ULN and HBeAg(+) patients with baseline ALT≥2.5 ULN,respectively.(3) For HBeAg(+) patients,viral breakthrough rate was significantly lower in patients with baseline HBV DNA<106 copies/ml than that in patients with baseline HBV DNA≥106 copies/ml patients (23.4% VS 46.3%,P<0.05) among HBeAg(+) patients.(4) The rate of HBV DNA loss,HBeAg loss,HBeAg seroconversion and viral breakthrough for the patients with IVR at week 24 were 76.3%,72.3%,40.8% and 28.9% compared to 47.6% (P<0.01),46% (P<0.01),12.7% (P<0.01) and 47.6% (P<0.05) for those without IVR.(4) For the 44 patients with viral breakthrough,32 were switched to Adefovir monotherapy or adefovir in combination with lamivudine therapy,and 12 continued to recieve lamivudine monotherapy.HBV DNA loss,HBeAg seroconversion were 40.6%,21.9% for those switch/add group compare to 16.7%,16.7% for the lamivudine monotherapy group.There were no significant differences in the background factors (sex,diagnosis,antiviral period,pre-tx ALT,pre-tx HBV DNA) between these two groups.Conclusion Both the baseline ALT and HBV DNA are associated with the efficacy of lamivudine in chronic hepatitis B patients.Patients with baseline ALT≥2.5×ULN and (or) HBV DNA level of < 1×106 copies/ml have better efficacy and lower rate of breakthrough rate.IVR at week 24 is an important predictive factor of a favorable response to lamivudine therapy.For the patients with viral breakthrough,those switched to/added on Adefovir have a favorable result.
