CAJ | 학술논문

目的：观察拉米夫定在来氟米特联合甲泼尼龙治疗乙肝相关性肾炎（HBV-GN）患者抗病毒中的疗效及安全性。方法：纳入因 HBV-GN 接受甲泼尼龙联合来氟米特治疗的41例患者，根据有无抗病毒治疗指征分为预防组及治疗组给予拉米夫定治疗，同时选取15例拉米夫定治疗的慢性乙型肝炎患者作为对照组。观察患者生化学、病毒学及血清学应答情况以及治疗过程中血清 IFN-γ及 IL-4的变化。结果：治疗48周时，预防组及治疗组生化学、病毒学及血清学应答与对照组比较均无明显差异；预防组及治疗组 IFN-γ水平及 IFN-γ/ IL-4较对照组明显下降（P ＜0．05）。所有患者均未出现严重不良反应。结论：拉米夫定抗病毒治疗对于使用来氟米特联合激素治疗的 HBV-GN 患者有较好的疗效及安全性，但来氟米特联合甲泼尼龙抑制机体 IFN-γ生产，影响乙肝病毒的清除。
목적：관찰랍미부정재래불미특연합갑발니룡치료을간상관성신염（HBV-GN）환자항병독중적료효급안전성。방법：납입인 HBV-GN 접수갑발니룡연합래불미특치료적41례환자，근거유무항병독치료지정분위예방조급치료조급여랍미부정치료，동시선취15례랍미부정치료적만성을형간염환자작위대조조。관찰환자생화학、병독학급혈청학응답정황이급치료과정중혈청 IFN-γ급 IL-4적변화。결과：치료48주시，예방조급치료조생화학、병독학급혈청학응답여대조조비교균무명현차이；예방조급치료조 IFN-γ수평급 IFN-γ/ IL-4교대조조명현하강（P ＜0．05）。소유환자균미출현엄중불량반응。결론：랍미부정항병독치료대우사용래불미특연합격소치료적 HBV-GN 환자유교호적료효급안전성，단래불미특연합갑발니룡억제궤체 IFN-γ생산，영향을간병독적청제。
Objective To investigate the efficacy and safety of lamivudine in the patients of hepatitis B virus-associated glomerulonephritis (HBV-GN) treated by prednisolone with leflunomide. Methods 41 HBV-GN patients treated by prednisolone and leflunomide were enrolled in this study. According to the presence of the indications of antiviral treatment, the patients were divided into the prevention group and the treatment group received lamivudine treatment, and another 15 patients with chronic hepatitis B were treated with lamivudine as the control group. The biochemical, virological and serological responses during the process of the treatment and the serum levels of IFN-γ and IL-4 were determined. Results No significant differences of biochemical, virological and serological responses in the prevention and treatment groups compared with the control group at 48 weeks after treatment. Levels of the IFN-γ and IFN-γ / IL-4 decreased significantly in the prevention group and treatment groups compared with the control group (P < 0.05, respectively). No serious adverse reactions occurred in all patients. Conclusion The antiviral treatment of lamivudine lead to good curative effect and security in HBV-GN patients received hormones combined with leflunomide treatments, but leflunomide with prednisolone inhibited the production of IFN-γ and removal of hepatitis B virus.