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目的评价乙型肝炎病毒外膜大蛋白(HBV-LP)在阿德福韦酯(ADV)联合拉米夫定(LAM)抗病毒治疗慢性乙型肝炎患者(CHB)中的应用价值。方法选取54例CHB患者,给予ADV 10 mg、LAM 100 mg,口服,qd治疗48周。采用上转发光免疫层析技术(UPT-LF)检测患者基线及治疗后12周、24周、36周、48周血清样品HBV-LP含量;应用实时荧光定量PCR法检测HBV DNA;化学发光法检测乙肝五项指标。结果 ADV联合LAM治疗48周后,75.9%(41/54)的患者出现病毒学应答,HBV-LP和HBV DNA水平均显著下降,但与HBV DNA比较,血清HBV-LP水平下降延迟。ROC曲线分析结果显示,基线血清HBV-LP水平高于30.12 U/ml患者预测病毒学无应答的AUC为0.827(P<0.01),治疗12周和24周后,HBV-LP高血清水平与病毒学无应答关联,AUC分别为0.844、0.850(P<0.01)。结论联合HBV-LP和HBV DNA检测更有利于抗HBV药物治疗CHB患者病毒学应答水平的预测和抗病毒治疗终点的判断,基线HBV-LP水平高于30.12 U/ml患者不推荐采用ADV联合LAM的抗病毒治疗方案。
Objective To evaluate the value of hepatitis B virus outer membrane protein (HBV-LP) in patients with chronic hepatitis B (ADV) combined with lamivudine (LAM) antiviral therapy. Methods 54 patients with CHB were enrolled in this study. ADV 10 mg and LAM 100 mg were given orally and qd for 48 weeks. Serum HBV-LP levels at baseline, 12 weeks, 24 weeks, 36 weeks and 48 weeks after treatment were detected by UPT-UP assay. HBV DNA was detected by real-time fluorescence quantitative PCR. Chemiluminescence Detection of hepatitis B five indicators. Results After 48 weeks of treatment with ADV and LAM, virological response was found in 75.9% (41/54) of patients. The levels of HBV-LP and HBV DNA were significantly decreased. However, serum HBV-LP level was delayed compared with HBV DNA. The ROC curve analysis showed that the predicted AUC of virological non-response was 0.827 (P <0.01) at the baseline serum HBV-LP level higher than 30.12 U / ml. After 12 weeks and 24 weeks of treatment, No association was found in response, with AUCs of 0.844 and 0.850, respectively (P <0.01). Conclusions Combined detection of HBV-LP and HBV DNA is more favorable for predicting the virological response level of CHB patients treated with anti-HBV drugs and judging the endpoint of antiviral therapy. Patients with baseline HBV-LP level higher than 30.12 U / ml are not recommended ADV with LAM Antiviral treatment programs.