CAJ | 학술논문

目的观察干扰素与拉米夫定序贯治疗慢性乙型肝炎的疗效,探索治疗慢性乙型肝炎的有效方法.方法 107例患者随机分成A组(拉米夫定序贯干扰素组):先口服拉米夫定,再肌肉注射干扰素；B组(拉米夫定组)口服拉米夫定；C组(干扰素组)肌肉注射干扰素.观察治疗结束时、治疗结束后6个月和12个月ALT复常率、HBeAg阴转率、HBeAg/Ab-HBe血清转换率、HBV-DNA阴转率和治疗后YMDD突变率.结果 ALT复常率治疗结束后6个月、12个月A组为85.3％、82.4％,均高于B组59.5％、47.6％ (P ＜0.05)；HBeAg阴转率治疗结束时、治疗结束后6个月和12个月A组为58.8％、55.9％、55.9％,均明显高于B组28.6％、21.4％、16.7％(P＜0.01),且高于C组32.3％、29.0％、29.0％ (P ＜0.05)；HBV-DNA阴转率治疗结束时A组88.2％明显高于C组38.7％(P＜0.01)；治疗结束后6个月和12个月A组为82.4％、73.5％,均明显高于B组47.6％、38.1％和C组35.5％、32.3％ (P ＜0.01)；HBeAg/Ab-HBe血清转换率治疗结束时A组52.9％高于B组16.7％和C组29.0％ (P ＜0.05)；治疗后YMDD突变率A组8.8％低于B组28.6％ (P ＜0.05).结论拉米夫定与干扰素序贯治疗优于单用拉米夫定及干扰素,两者序贯治疗有良好的协同作用,优势互补,既能提高近期疗效、减少反跳,又能降低病毒变异率和远期复发率.
목적 관찰간우소여랍미부정서관치료만성을형간염적료효,탐색치료만성을형간염적유효방법.방법 107례환자수궤분성A조(랍미부정서관간우소조):선구복랍미부정,재기육주사간우소；B조(랍미부정조)구복랍미부정；C조(간우소조)기육주사간우소.관찰치료결속시、치료결속후6개월화12개월ALT복상솔、HBeAg음전솔、HBeAg/Ab-HBe혈청전환솔、HBV-DNA음전솔화치료후YMDD돌변솔.결과 ALT복상솔치료결속후6개월、12개월A조위85.3％、82.4％,균고우B조59.5％、47.6％ (P ＜0.05)；HBeAg음전솔치료결속시、치료결속후6개월화12개월A조위58.8％、55.9％、55.9％,균명현고우B조28.6％、21.4％、16.7％(P＜0.01),차고우C조32.3％、29.0％、29.0％ (P ＜0.05)；HBV-DNA음전솔치료결속시A조88.2％명현고우C조38.7％(P＜0.01)；치료결속후6개월화12개월A조위82.4％、73.5％,균명현고우B조47.6％、38.1％화C조35.5％、32.3％ (P ＜0.01)；HBeAg/Ab-HBe혈청전환솔치료결속시A조52.9％고우B조16.7％화C조29.0％ (P ＜0.05)；치료후YMDD돌변솔A조8.8％저우B조28.6％ (P ＜0.05).결론 랍미부정여간우소서관치료우우단용랍미부정급간우소,량자서관치료유량호적협동작용,우세호보,기능제고근기료효、감소반도,우능강저병독변이솔화원기복발솔.
Objective To observe the responses of chronic hepatitis B patients treated by interferon and lamivudine sequentially and to explore the effective method for the treatment of chronic hepatitis B.Methods 107 patients were randomly divided into 3 groups.The patients in group A (sequential lamivudine and interferon group) first received lamivudine,then intramuscular injection of interferon.The patients in group B (lamivudine group) were administrated with lamivudine alone.The patients in group C (interferon group) were injected with interferon alone.The rates of ALT returning to normal,HBeAgloss,HBeAg/antiHBe seroconversion,undetectable HBV-DNA and YMDD mutation at the end of treatment,6 months after treatment and 12 months after treatment were calculated.Results After treatment for 6 months,12 months,rate of ALT retuning to normal in group A were 85.3％ and 82.4％,respectively.Both were higher than those in group B (59.5％ and 47.6％,P ＜ 0.05).The rate of HBeAg loss at the end of the treatment,6 months and 12 months after treatment in group A were 58.8％,55.9％ and 55.9％,respectively and were higher than that of group B (28.6％,21.4％,and 16.7％,P ＜0.01)and group C (32.3％,29.0％,and 29.0％,P ＜ 0.05).At the end of the treatment,the rate of undetectable HBV-DNA in group A was 88.2％ and was higher than group C (38.7％,P ＜0.01).At 6 months and 12 months after treatment,the rate of undetectable HBV-DNA in group A were 82.4％ and 73.5％,respectively,and were significantly higher than that of group B (47.6％ and 38.1％) and group C (35.5％ and 32.3％,P ＜0.01).At the end of the treatment HBeAg/Ab-HBe seroconversion rate in group A was 52.9％,higher than 16.7％ in group B and 29.0％ in group C(P ＜0.05).After treatment,the YMDD mutation rate in group A was 8.8％,which was lower than 28.6％ in group B (P ＜ 0.05).Conclusions Sequential therapy with lamivudine and interferon is superior to lamivudine or interferon alone in synergistic effect.The therapy will not only improve the recent curative effect and reduce the bounce,but also reduce the virus mutation rates and long-term recurrence rate.