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目的:观察拉米夫定治疗慢乙肝(CHB)患者的疗效,探讨拉米夫定治疗慢乙肝的病毒学反弹的预测因素。方法:146例CHB患者予拉米夫定100mg/d,随访治疗12个月以上,检测基线、治疗后每个月、HBV DNA转阴后3个月的HBV DNA拷贝数、定量HBeAg及ALT指标,以分析疗程、基线HBV DNA、定量HBeAg、ALT指标、治疗3、6个月病毒学应答与病毒学反弹的关系。结果:①在疗程12~18个月组中,基线HBV DNA5log10~组病人病毒学反弹率低于6log10~组病人和≥7log10组病人(P<0.05),基线ALT<2ULN病人病毒学反弹率高于2~5ULN组病人(P<0.05);②在疗程19~24个月中治疗6个月有病毒学应答病人与无应答病人反弹率分别为21.7%和55.6%,差异有统计学意义(P<0.05)。结论:基线HBV DNA水平和ALT水平是疗程12~18个月时病毒反弹的重要预测指标;治疗6个月病毒学应答可以预测19~24个月的维持应答。
Objective: To observe the curative effect of lamivudine on chronic hepatitis B (CHB) and to explore the predictors of virological rebound of lamivudine in treating chronic hepatitis B (CHB). Methods: One hundred and sixty-six patients with CHB were treated with lamivudine 100 mg once daily for 12 months. The HBV DNA copy number, HBV DNA copy number, HBeAg and ALT index , To analyze the course of treatment, baseline HBV DNA, quantitative HBeAg, ALT indicators, the treatment of 3,6 months virological response and virological rebound relationship. Results: (1) The virological rebound rate of baseline HBV DNA5log10 ~ group was lower than that of 6log10 ~ group and ≥7log10 group (P <0.05) in the 12 ~ 18 months of treatment course, and the high virological rebound rate of patients with baseline ALT <2ULN (P <0.05); ②The rebound rates of patients with virological response and non-responders were 21.7% and 55.6%, respectively, for 6 months after treatment for 19 to 24 months, with significant difference (P < P <0.05). Conclusions: Baseline HBV DNA levels and ALT levels are important predictors of virus rebound at 12-18 months of treatment; virologic response at 6 months predicted a 19- to 24-month maintenance response.