CAJ | 학술논문

目的评价HBeAg阳性慢性乙型肝炎患者治疗前ALT、HBeAg、HBV DNA水平以及治疗12周时HBV抑制程度对阿德福韦酯(ADV)治疗52周患者疗效的预测价值.方法 98例HBeAg阳性成年慢性乙型肝炎患者进入研究.筛选时血浆HBV DNA定量≥1×106拷贝/ml,血清ALT水平1.5～10倍正常值上限(ULN).患者接受ADV 10mg/d,共52周治疗.定期随访,检测血清HBV标志物及HBV DNA.比较不同基线ALT、HBeAg、HBV DNA水平以及治疗12周时不同血清HBV DNA水平患者治疗52周时的疗效差异. 结果 ADV治疗52周时,血清HBV DNA＜103拷贝/ml的患者,基线ALT＞5 × ULN者(72.7%)高于ALT＜2×ULN者(38.0%),P＜0.05;基线HBeAg≤350 s/co者(66.7%)高于HBeAg＞350 s/co者(30.2%),P＜0.01;基线HBV DNA≤108拷贝/ml者(53.0%)高于血清HBV DNA＞108拷贝/ml者(34.4%),P＜0.05.52周HBeAg血清学转换率在基线HBeAg水平≤350 s/co者和HBeAg＞350 s/co者分别为42.2%和7.5%(P＜0.01).治疗12周时血清HBV DNA＜103拷贝/ml、103～105拷贝/ml和＞105拷贝/ml组患者,52周时血清HBV DNA＜103拷贝/ml的比例分别为82.6%、57.1%和17.5%,组间差异均有统计学意义(P值均＜0.05);3组患者HBeAg血清学转换率分别为52.2%、25.7%和5.0%,组间差异均有统计学意义(P值均＜0.05);3组患者52周ALT复常率分别为100%、83%和75%,血清HBV DNA＜103拷贝/ml组高于＞105拷贝/ml组(P＜0.05).相关分析显示,治疗52周时的血清HBV DNA水平及HBeAg血清转换与治疗12周时血清HBV DNA水平中度相关(P＜0.01).结论 HBeAg阳性慢性乙型肝炎患者ADV治疗12周时血清HBV DNA水平对治疗52周的疗效的预测价值优于基线指标,治疗12周时血清HBV DNA＜103拷贝/ml者,52周时能达到更佳的疗效.
목적 평개HBeAg양성만성을형간염환자치료전ALT、HBeAg、HBV DNA수평이급치료12주시HBV억제정도대아덕복위지(ADV)치료52주환자료효적예측개치.방법 98례HBeAg양성성년만성을형간염환자진입연구.사선시혈장HBV DNA정량≥1×106고패/ml,혈청ALT수평1.5～10배정상치상한(ULN).환자접수ADV 10mg/d,공52주치료.정기수방,검측혈청HBV표지물급HBV DNA.비교불동기선ALT、HBeAg、HBV DNA수평이급치료12주시불동혈청HBV DNA수평환자치료52주시적료효차이. 결과 ADV치료52주시,혈청HBV DNA＜103고패/ml적환자,기선ALT＞5 × ULN자(72.7%)고우ALT＜2×ULN자(38.0%),P＜0.05;기선HBeAg≤350 s/co자(66.7%)고우HBeAg＞350 s/co자(30.2%),P＜0.01;기선HBV DNA≤108고패/ml자(53.0%)고우혈청HBV DNA＞108고패/ml자(34.4%),P＜0.05.52주HBeAg혈청학전환솔재기선HBeAg수평≤350 s/co자화HBeAg＞350 s/co자분별위42.2%화7.5%(P＜0.01).치료12주시혈청HBV DNA＜103고패/ml、103～105고패/ml화＞105고패/ml조환자,52주시혈청HBV DNA＜103고패/ml적비례분별위82.6%、57.1%화17.5%,조간차이균유통계학의의(P치균＜0.05);3조환자HBeAg혈청학전환솔분별위52.2%、25.7%화5.0%,조간차이균유통계학의의(P치균＜0.05);3조환자52주ALT복상솔분별위100%、83%화75%,혈청HBV DNA＜103고패/ml조고우＞105고패/ml조(P＜0.05).상관분석현시,치료52주시적혈청HBV DNA수평급HBeAg혈청전환여치료12주시혈청HBV DNA수평중도상관(P＜0.01).결론 HBeAg양성만성을형간염환자ADV치료12주시혈청HBV DNA수평대치료52주적료효적예측개치우우기선지표,치료12주시혈청HBV DNA＜103고패/ml자,52주시능체도경가적료효.
Objective To study the predictive value of ALT,HBeAg and HBV DNA levels at baseline and HBV DNA levels at week 12 adefovir dipivoxil(ADV)treatment to the efficacy of it at week 52 in patients with HBeAg-positive chronic hepatitis B (CHB).Methods Ninety-eight HBeAg-positive CHB patients with serum HBV DNA≥1×106 copies/ml and ALT levels between 1.5 to 10 times of upper limits of normal(ULN)were enrolled in the study.Ten mg/d of ADV was administered for 52 weeks.Line serum samples were collected for measuring HBV DNA and HBV markers.The efficacy of the treatment at week 52 was evaluated in patients wim diflferent ALT, HBeAg and HBV DNA levels at baseline and HBV DNA levels at week 12 after treatment.Results At week 52 of ADV treatment, the rates of HBV DNA＜103 were 72.7%,66.7% and 53.0% respectively in patients with ALT＞5 × ULN, HBeAg≤350 s/co and HBV DNA≤108 copies/ml.Significant differences were found between them and patients with ALT<2×ULN(38.0%,P＜0.05),HBeAg＞350 s/co(30.2%,P＜0.01)and HBV DNA＞108 copies/ml(34.4%,P＜0.05)at baseline.HBeAg seroconversion rates were 42.2%and 7.5%(P＜0.0 1)in patients with HBeAg titer≤350 and＞350 S/co at baseline.In patients with HBV DNA＜103,103-105 and ＞105 copies/ml at week 12,the ratios of them with HBV DNA＜103 copies/ml at week 52 were 82.6%,57.1%and 17.5%and significant differences were found between these groups(P＜0.05);HBeAg seroconversion rates were 52.2%,25.7%and 5.0%(P＜0.05);ALT normalization rates were 100%,83%and 75%,significantly higher in patiems with HBV DNA＜103 copies/ml than those with HBV DNA＞105 copies/ml(P＜0.05)at week 12.HBV DNA and HBeAg seroconversion at week 52 correlated with HBV DNA levels at week 12(r=0,6 and r=0.5 respectively,P＜0.01).Conclusions In HBeAg-positive CHB patients treated with adefovir dipivoxil,HBV DNA levels at week 12 can be used to predict the efficacy at week 52.HBV DNA＜103copies/ml at week 12 predict a better treatment result at week 52.