拉米夫定联合干扰素治疗慢性乙型肝炎的疗效观察(1)
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[摘要] 目的：观察拉米夫定与干扰素联合用药治疗慢性乙型肝炎的疗效。方法：将150例慢性乙型肝炎患者随机分为三组，各50 例。联合组给予拉米夫定和重组人干扰素α-2b治疗，拉米夫定组单给予拉米夫定治疗；干扰素组单给予干扰素治疗，疗程均为1年。结果：治疗1年后，联合组HBV-DNA转阴率为86%，血清HBeAg/抗HBe转换率为48%，均优于拉米夫定组和干扰素组(P<0.05)。联合组仅出现1例YMDD变异(2%)，而拉米夫定组出现8例YMDD变异(16%)。结论：拉米夫定联合干扰素治疗效果优于单独应用组，并且能减少病毒YMDD变异，防止耐药发生。
[关键字] 拉米夫定；干扰素；慢性乙型肝炎
[中图分类号] R512.62[文献标识码]B [文章编号]1673-7210(2010)10(a)-047-02
Clinical observation on Lamivudine combination Interferon treatment patients with chronic hepatitis B
DING Ningling, ZHU Xiang, WANG Yongping
(Department of Contagion, the Fifth People′s Hospital of Suzhou, Suzhou215007, China)
[Abstract] Objective: To observe the effect of Lamivudine combination Interferon in the treatment of patients with chronic hepatitis B. Methods: 150 patients with chronic hepatitis B were divided into 3 groups, each group had 50 patients. The patients in combination group received Lamivudine and Interferonα-2b therapy for one year, the patients in lamivudine group and interferon group received lamivudine and interferonα-2b therapy respectively for one year. Results: After one year, the HBVDNA loss and HBeAg/anti-HBe seroconversion in combination group were 86% and 48%, respectively. They were higher than in Lamivudine group and Interferon group (P<0.05), YMDD mutations were detected in one patients in combination group (2%), but 8 patients in Lamivudine group (16%). Conclusion: Lamivudine combination Interferon in the treatment of patients with chronic hepatitis B get a better effect and decrease YMDD mutation.
[Key words] Lamivudine; Interferon; Hepatitis B
慢性乙型肝炎是世界广泛流行的传染病，可发展为肝硬化、肝癌等严重肝脏疾病，是一种危害人类健康的传染病。近年来，慢性乙型肝炎首选核苷类抗病毒药物拉米夫定及免疫调节剂重组人α干扰素治疗已经取得了一定的效果，但这些药物只能抑制病毒复制，并不能彻底清除感染者体内的病毒，单独应用疗效有限，且有一些副反应，探讨有效的联合疗法非常必要，本院近两年来采用拉米夫定联合干扰素治疗慢性乙型肝炎取得了较好疗效，总结如下：
1 资料与方法
1.1 一般资料
选择2007年1月～2009年1月的慢性乙型肝炎患者150例，其中，男80例，女70例，年龄19～57岁，平均36.2岁。诊断符合全国传染病与寄生虫病学术会议修订的《病毒性肝炎防治方案》的标准[1]。入选标准：患者血清HBsAg、HBeAg、HBV-DNA呈阳性；ALT在正常上限的2倍以上；无HAV、HCV、HDV、HEV、HIV重叠感染及自身免疫性肝病。患者了解治疗全过程，掌握治疗过程中的注意事项，不随意停用。排除标准：近期接受抗病毒药物及免疫调节剂治疗者；患有心脏病、肾病及有糖尿病病史者；有酗酒和吸毒史者；妊娠或哺乳期妇女 ......
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