拉米夫定和α-干扰素序贯治疗e抗原阴性乙肝患者及其对拉米夫定耐药突变的抑制

摘要

Objective: To evaluate the effect of lamivudine and interferon sequential treatment of patients with chronic hepatitis be antigen negatie.Methods: 162 cases of e antigen negatie patients with chronic hepatitis b treatment were studied.98 cases were treated by lamivudine alone 100 mg, daily.Continuous treatment for 48 weeks (group B).64 patients were first used alone lamivudine 100 mg every day, continuous treatment for 20 weeks, then combination, increase of alpha interferon 5 million units, 3 times a week, continuous treatment after 4 weeks, instead of alpha interferon used alone (5 million units, 3 times a week), continuous treatment 24 weeks (group A).All patients continue treatment 24 weeks.Results: After 48 weeks of treatment, ALT complex and often HBV-DNA reduced to less than 1 000 copies/ml in the percentage of patients in both groups were not significantly different.Lamivudine treatment group ALT alone complex and often HBV-DNA less than 1 000 copies/ml ratio for 55.1％, interferon sequential treatment group two ratio for 59.36％ and 56.25％.And in the treatment of 72 weeks, ALT complex often proportion of group A (53％) was obviously higher than group B (36％) (P＜0.05).And the patient was happened in lamivudine resistance mutations proportion of group B (22.45％) was obviously higher than group A (P＜0.05).Conclusion: With sequential lamivudine and a-interferon treatment of chronic hepatitis B patients treated with lamivudine alone as effective.Sequential treatment of lamivudine more inhibited restrained mutants production.%目的:评价拉米夫定和α-干扰素序贯治疗e抗原阴性乙肝患者的功效.方法:本研究共进行了162例e抗原阴性的慢性乙肝患者的治疗研究.其中98例患者采用拉米夫定单独用药,100 mg/d,持续治疗48周(B组).64例患者先单独用拉米夫定,100 mg/d,持续治疗20周,然后联合用药,增加α-干扰素500万U,每周3次,持续治疗4周后,改为单独用α-干扰素(500万U,每周3次),持续治疗24周(A组).所有的患者都再持续治疗24周.结果:经过48周的治疗,ALT水平复常和HBV-DNA降至<1 000 copies/ml的患者比例在两组中并没有明显不同.拉米夫定单独治疗组ALT水平复常和HBV-DNA<1 000 copies/ml的比例为55.1%,干扰素序贯治疗组两项的比例为59.36%和56.25%.而在治疗72周时,ALT水平复常的比例A组(53%)明显高于B组(36%)(P<0.05).而且此时患者中发生拉米夫定耐药突变的比例B组(22.45%)明显高于A组(P<0.05).结论:用拉米夫定和α-干扰素序贯治疗慢性乙肝患者与用拉米夫定单独治疗同样有效,序贯治疗更加抑制了拉米夫定耐药突变的产生.