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目的观察聚乙二醇干扰素-α-2a治疗24周应答不佳的e抗原阳性的慢性乙型肝炎患者优化治疗方法。方法选取医院收治的聚乙二醇干扰素-α-2a治疗24周应答不佳的e抗原阳性的慢性乙型肝炎患者79例为研究对象,随机分为观察组40例和对照组39例。观察组在经24周干扰素治疗效果不佳后转换为使用拉米夫定治疗,对照组在经24周干扰素治疗效果不佳后转换为使用干扰素和阿德福韦酯治疗。观察2组患者的HBeAg血清转换率、HBeAg的阴转率、ALT复常率、HBsAg血清转换率、HBsAg的阴转率等各项指标。结果观察组患者的HBeAg血清转换率、HBeAg的阴转率、ALT复常率、HBsAg血清转换率、HBsAg的阴转率均高于对照组,差异有统计学意义(P<0.05)。结论转换使用拉米夫定在干扰素治疗24周应答不佳的e抗原阳性的慢性乙型肝炎患者的治疗过程中,能取得更好的治疗效果,值得临床进一步探讨研究。
Objective To observe the optimal treatment of chronic hepatitis B patients with e antigen-positive response to pegylated interferon-α-2a for 24 weeks with poor response. Methods 79 patients with e antigen positive chronic hepatitis B who had poor response at 24 weeks after treatment with peginterferon alfa-2a in hospital were enrolled and divided into observation group (40 cases) and control group (39 cases) randomly. The observation group switched to lamivudine treatment after 24 weeks of interferon treatment failure and the control group switched to interferon and adefovir dipivoxil treatment after 24 weeks of interferon treatment. The HBeAg seroconversion rate, HBeAg negative conversion rate, ALT normalization rate, HBsAg seroconversion rate and HBsAg negative conversion rate were observed in two groups of patients. Results The HBeAg seroconversion rate, HBeAg negative conversion rate, ALT normalization rate, HBsAg seroconversion rate and HBsAg negative conversion rate in observation group were significantly higher than those in control group (P <0.05). Conclusion The conversion of lamivudine in patients with poor response e antigen-positive chronic hepatitis B at 24 weeks of interferon treatment can achieve a better therapeutic effect, which deserves clinical further study.