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目的研究干扰素(interferon,IFN)联合拉米夫定(LAM)治疗HBe Ag阳性代偿期乙型肝炎肝硬化儿童患者的疗效与安全性。方法给予26例入选患者IFN(3~6 MU/m2,隔日1次)联合LAM[3 mg/(kg·d)]治疗48周,观察基线和治疗12、24、36、48周的HBV血清学标志物、HBV DNA定量、生化指标及不良反应。结果治疗12、24、36、48周时HBe Ag清除率分别为30.8%、42.3%、53.8%和53.8%,HBe Ag血清学转换率分别为23.1%、34.6%、46.2%和46.2%,HBs Ag清除率分别为0、11.5%、19.2%和19.2%,HBs Ag血清学转换率分别为0、3.8%、19.2%和19.2%,HBV DNA低于检测下限率分别为38.5%、53.8%、73.1%和84.6%,ALT复常率分别为88.5%、92.3%、92.3%和96.2%。随着疗程的延长,HBe Ag清除/血清学转换率、HBs Ag清除/血清学转换率、HBV DNA低于检测下限率和ALT复常率均逐渐升高(P均<0.05)。未见明显不可耐受的不良反应。结论 IFN联合LAM治疗HBe Ag阳性代偿期乙型肝炎肝硬化儿童患者具有良好的疗效和安全性。
Objective To investigate the efficacy and safety of interferon (IFN) combined with lamivudine (LAM) in the treatment of children with HBeAg-positive decompensated hepatitis B cirrhosis. Methods Twenty-six patients with IFN (3-6 MU / m2, once every other day) and LAM [3 mg / (kg · d)] were given for 48 weeks. The baseline and serum HBV at 12, 24, 36 and 48 weeks Study markers, HBV DNA quantification, biochemical indicators and adverse reactions. Results HBeAg clearance rates were 30.8%, 42.3%, 53.8% and 53.8% at 12, 24, 36 and 48 weeks of treatment, respectively. HBeAg seroconversion rates were 23.1%, 34.6%, 46.2% and 46.2% The seroconversion rates of HBs Ag were 0, 3.8%, 19.2% and 19.2%, respectively. The detection rates of HBV DNA below the limit of detection were 38.5%, 53.8%, respectively. 73.1% and 84.6% respectively, and the recovery rates of ALT were 88.5%, 92.3%, 92.3% and 96.2% respectively. With prolonged course of treatment, HBe Ag clearance / seroconversion rate, HBs Ag clearance / seroconversion rate, HBV DNA below detection limit and ALT normalization rate increased gradually (all P <0.05). No obvious intolerable adverse reactions. Conclusion IFN combined with LAM has good curative effect and safety in children with HBeAg-positive decompensated hepatitis B cirrhosis.