CAJ | 학술논문

目的：探讨拉米夫定／阿德福韦／恩替卡韦经治的乙型肝炎E抗原（ HBeAg）阳性慢性乙型病毒性肝炎育龄女性患者治疗方案的持续疗效性、病毒学耐药率／突破率、胎儿安全性等优劣性，为临床医师为该群体选择抗病毒治疗方案提供充实的理论数据。方法：研究对象为2011年1月—2012年12月接受拉米夫定／阿德福韦酯／恩替卡韦治疗且有意愿生育的年轻女性患者，以随机数字表法分为治疗组和对照组，每组各50例患者。治疗组患者在原来的抗病毒药基础上加用聚乙二醇干扰素α-2a，对照组患者停用原来的抗病毒药，改用替比夫定，分别于治疗12、24、48周后对各组随诊1次，每次复查并记录血常规、肝功能、乙肝病毒脱氧核糖核酸（ HBV DNA）定量、乙肝病毒表面抗原（ HBsAg）、HBeAg、乙型肝炎E抗体定量、乙肝病毒YMDD变异等。若患者日后妊娠，则统计产后并发症的发生情况、新生儿出生时的一般情况以及HBsAg等情况。结果：2组患者治疗第12周时HBV DNA定量低于检出限、HBeAg转阴、HBeAg血清转换的病例数比较，差异无统计学意义（ P＞0.05）；治疗组患者在治疗第24周和第48周的HBV DNA低于检出限、HBeAg转阴、HBeAg血清转换的病例数均明显多于对照组，差异有统计学意义（ P＜0.05）。治疗前，2组患者肝功能指标的差异无统计学意义（P＞0.05）；经过48周的治疗，治疗组患者的丙氨酸转氨酶、天门冬氨酸转氨酶、直接胆红素、总胆红素水平明显低于对照组，差异有统计学意义（P＜0.05）。2组患者妊娠并发症发生率的差异无统计学意义（P＞0.05）；2组出生的新生儿在胎龄、胎儿体质量及Apger评分等方面的差异无统计学意义（P＞0.05）。结论：通过干扰素强化治疗达到停药标准后进行妊娠，可以减轻患者长期服药的费用支出以及克服服药妊娠的心理负担，可以考虑作为妊娠前抗病毒治疗的首选方案。目的：探討拉米伕定／阿德福韋／恩替卡韋經治的乙型肝炎E抗原（ HBeAg）暘性慢性乙型病毒性肝炎育齡女性患者治療方案的持續療效性、病毒學耐藥率／突破率、胎兒安全性等優劣性，為臨床醫師為該群體選擇抗病毒治療方案提供充實的理論數據。方法：研究對象為2011年1月—2012年12月接受拉米伕定／阿德福韋酯／恩替卡韋治療且有意願生育的年輕女性患者，以隨機數字錶法分為治療組和對照組，每組各50例患者。治療組患者在原來的抗病毒藥基礎上加用聚乙二醇榦擾素α-2a，對照組患者停用原來的抗病毒藥，改用替比伕定，分彆于治療12、24、48週後對各組隨診1次，每次複查併記錄血常規、肝功能、乙肝病毒脫氧覈糖覈痠（ HBV DNA）定量、乙肝病毒錶麵抗原（ HBsAg）、HBeAg、乙型肝炎E抗體定量、乙肝病毒YMDD變異等。若患者日後妊娠，則統計產後併髮癥的髮生情況、新生兒齣生時的一般情況以及HBsAg等情況。結果：2組患者治療第12週時HBV DNA定量低于檢齣限、HBeAg轉陰、HBeAg血清轉換的病例數比較，差異無統計學意義（ P＞0.05）；治療組患者在治療第24週和第48週的HBV DNA低于檢齣限、HBeAg轉陰、HBeAg血清轉換的病例數均明顯多于對照組，差異有統計學意義（ P＜0.05）。治療前，2組患者肝功能指標的差異無統計學意義（P＞0.05）；經過48週的治療，治療組患者的丙氨痠轉氨酶、天門鼕氨痠轉氨酶、直接膽紅素、總膽紅素水平明顯低于對照組，差異有統計學意義（P＜0.05）。2組患者妊娠併髮癥髮生率的差異無統計學意義（P＞0.05）；2組齣生的新生兒在胎齡、胎兒體質量及Apger評分等方麵的差異無統計學意義（P＞0.05）。結論：通過榦擾素彊化治療達到停藥標準後進行妊娠，可以減輕患者長期服藥的費用支齣以及剋服服藥妊娠的心理負擔，可以攷慮作為妊娠前抗病毒治療的首選方案。
목적：탐토랍미부정／아덕복위／은체잡위경치적을형간염E항원（ HBeAg）양성만성을형병독성간염육령녀성환자치료방안적지속료효성、병독학내약솔／돌파솔、태인안전성등우렬성，위림상의사위해군체선택항병독치료방안제공충실적이론수거。방법：연구대상위2011년1월—2012년12월접수랍미부정／아덕복위지／은체잡위치료차유의원생육적년경녀성환자，이수궤수자표법분위치료조화대조조，매조각50례환자。치료조환자재원래적항병독약기출상가용취을이순간우소α-2a，대조조환자정용원래적항병독약，개용체비부정，분별우치료12、24、48주후대각조수진1차，매차복사병기록혈상규、간공능、을간병독탈양핵당핵산（ HBV DNA）정량、을간병독표면항원（ HBsAg）、HBeAg、을형간염E항체정량、을간병독YMDD변이등。약환자일후임신，칙통계산후병발증적발생정황、신생인출생시적일반정황이급HBsAg등정황。결과：2조환자치료제12주시HBV DNA정량저우검출한、HBeAg전음、HBeAg혈청전환적병례수비교，차이무통계학의의（ P＞0.05）；치료조환자재치료제24주화제48주적HBV DNA저우검출한、HBeAg전음、HBeAg혈청전환적병례수균명현다우대조조，차이유통계학의의（ P＜0.05）。치료전，2조환자간공능지표적차이무통계학의의（P＞0.05）；경과48주적치료，치료조환자적병안산전안매、천문동안산전안매、직접담홍소、총담홍소수평명현저우대조조，차이유통계학의의（P＜0.05）。2조환자임신병발증발생솔적차이무통계학의의（P＞0.05）；2조출생적신생인재태령、태인체질량급Apger평분등방면적차이무통계학의의（P＞0.05）。결론：통과간우소강화치료체도정약표준후진행임신，가이감경환자장기복약적비용지출이급극복복약임신적심리부담，가이고필작위임신전항병독치료적수선방안。
OBJECTIVE:To study the sustained efficacy of the therapeutic regimen for women of childbearing age with HBeAg positive hepatitis B treated with lamivudine/adefovir/entecavir, virological resistance rates/breakthrough rate and fetal safety so as to provide theoretical data for clinicians in choosing antiretroviral therapy for this kind of patients.METHODS:Young female patients with HBeAg positive hepatitis B who were willing to give birth to child and treated with lamivudine/adefovir/entecavir between January 2011 and December 2012 were randomized to either experimental group or control group, of 50 cases in each group.The patients in the experimental group received add-on peginterferon α-2a plus original antiviral therapy, while those in the control group received telbivudine in which the original antiviral therapy was discontinues.The patients were followed-up at 12, 24 and 48 weeks for recording of blood routine, liver function, hepatitis B virus DNA ( HBV DNA ) quantification, HBsAg, HBeAg, E antibody quantitation of hepatitis B, and hepatitis B virus YMDD mutation.If pregnant in the future, the incidence of postpartum complications, general condition of neonate at the time of birth and HbsAg should be recorded.RESULTS:The differences between the two groups in the number of patients whose HBV-DNA quantification were lower than the detection limit, and who had negative-return of HbeAg and HBeAg seroconversion at 12 weeks were not statistically significant( P >0.05 ); however, at 24 and 48 weeks, there were significanly more patients whose HBV-DNA quantification were lower than the detection limit, and who had negative-return of HbeAg and HBeAg seroconversion in the experimental group than in the control group ( P<0.05 ) .There was no statistical significance in liver function indexes between the two groups before treatment ( P >0.05 ); at 48 weeks, the patients in the experimental group showed significantly lower levels in ALT, AST, DBIL and TBIL than in the control group ( P<0.05 ) .There were no statistically significant differences between the two groups in the incidence of pregnancy complications, gestational age, fetal body mass and fetal Apger score ( P >0.05 ) .CONCLUSIONS: Pregnancy of women after meeting criteria of discontinuation of interferon intensive therapy can reduce the expenses of long-term medication and help the patient overcome the psychological burden on medication during pregnancy, thus the interferon intensive therapy can be considered as the preferred antiviral therapy before pregnancy.