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目的 观察拉米夫定治疗慢性乙型肝炎患者的临床疗效、肝组织学改变及肝组织内乙型肝炎病毒(HBV)标志物的变化。方法 随机选择70例慢性乙型肝炎患者予口服拉米夫定100 mg/d,连用1年。观察HBV DNA、血清HBeAg/抗-HBe、肝功能以及血清肝纤维化指标的变化;对其中35例患者行治疗前后肝穿刺活检,行Knodell病理学评分,检测肝细胞内HBsAg、HBcAg、α平滑肌肌动蛋白(α—SMA)。结果 治疗结束时,完全应答率为23.73％,部分应答率为69.49％,无应答率为6.78％。发生HBeAg血清学转换的患者治疗前血清ALT水平明显高于未发生血清HBeAg转换的患者。41.18％患者肝组织学活动指数得以改善,汇管区坏死、门静脉炎症及纤维化明显改善。血清HBeAg转换组肝组织内HBcAg、α-SMA的表达明显减少,HBsAg的表达无显著性改变。治疗期间不良反应轻,安全性良好。结论 拉米夫定100 mg/d可以迅速降低血清HBVDNA和ALT的水平,促进HBeAg血清转换,减轻肝脏炎症坏死活动度,延缓肝纤维化的进展。
Objective To observe the clinical effects, changes of liver histology and changes of hepatitis B virus (HBV) markers in patients with chronic hepatitis B treated with lamivudine. Methods Seventy patients with chronic hepatitis B were randomized to receive lamivudine 100 mg once daily for 1 year. The changes of serum HBV DNA, serum HBeAg / anti-HBe, liver function and serum liver fibrosis were observed. Among 35 patients, the liver biopsy was performed before and after treatment, and the pathological score of Knodell was used to detect the intrahepatic HBsAg, HBcAg, Actin (α-SMA). Results At the end of treatment, the complete response rate was 23.73%, the partial response rate was 69.49%, and the non-response rate was 6.78%. Patients with HBeAg seroconversion before treatment serum ALT levels were significantly higher than those who did not occur serum HBeAg conversion. 41.18% of patients with liver activity index improved, portal area necrosis, portal vein inflammation and fibrosis significantly improved. The expression of HBcAg and α-SMA in the serum of HBeAg-transformed group decreased significantly, while the expression of HBsAg did not change significantly. Adverse reactions during treatment light, good safety. Conclusions Lamivudine 100 mg / d can rapidly reduce serum HBVDNA and ALT levels, promote HBeAg seroconversion, reduce the activity of liver inflammation and necrosis and delay the progression of liver fibrosis.