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目的观察恩替卡韦联合拉米夫定对慢性乙型肝炎患者外周血T细胞亚群和HBV-YMDD变异的影响。方法将60例治疗前未检测出HBV-YMDD变异并且HBV-DNA均为阳性的慢性乙肝患者随机分为研究组和对照组,研究组给予拉米夫定50 mg/d和恩替卡韦0.5 mg/d;对照组只给予拉米夫定100 mg/d,疗程12个月。分别在治疗前和治疗后第3个月、6个月、9个月、12个月检测患者外周血T细胞亚群、HBV-DNA含量及HBV-YMDD变异情况。结果与对照组相比,研究组患者在治疗后第3个月、6个月、9个月、12个月,外周血CD4+水平显著上升,差异有统计学意义(P<0.05);第6个月、9个月、12个月,CD8+水平显著下降(P<0.01),CD4+/CD8+比值上升(P<0.01),HBVDNA阴转率高(P<0.05);治疗后第3个月、6个月、9个月、12个月,HBV-YMDD变异例数少(P<0.05),差异均有统计学意义。结论恩替卡韦联合拉米夫定用药治疗慢性乙型肝炎更能有效的改善外周血T细胞亚群的功能、抑制HBV-DNA病毒的复制、减少HBV-YMDD变异。对乙肝患者更安全有效,值得推广应用。
Objective To observe the effects of entecavir and lamivudine on the variation of T-cell subsets and HBV-YMDD in peripheral blood of patients with chronic hepatitis B (HBV). Methods Sixty chronic hepatitis B patients without HBV-YMDD mutation and HBV-DNA were detected before treatment were randomly divided into study group and control group. The study group was given lamivudine 50 mg / d and entecavir 0.5 mg / d ; Control group only given lamivudine 100 mg / d, treatment for 12 months. Peripheral blood T lymphocyte subsets, HBV-DNA content and HBV-YMDD mutation were detected before treatment, 3 months, 6 months, 9 months and 12 months after treatment. Results Compared with the control group, the level of CD4 + in the peripheral blood of the study group increased significantly at the third month, the sixth month, the ninth month and the 12th month after treatment (P <0.05) (P <0.01), the ratio of CD4 + / CD8 + increased (P <0.01), and the negative rate of HBVDNA increased (P <0.05) at the first month, the third month, the ninth month and the 12th month. The number of HBV-YMDD mutation was less at 6 months, 9 months and 12 months (P <0.05), and the differences were statistically significant. Conclusion Entecavir combined with lamivudine treatment of chronic hepatitis B can effectively improve the function of peripheral blood T cell subsets, inhibit the replication of HBV-DNA virus and reduce the HBV-YMDD mutation. Hepatitis B patients safer and more effective, it is worth promoting application.