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目的研究拉米夫定治疗慢性乙型肝炎12周HBV DNA定量检测结果对治疗96周疗效HBV DNA<103拷贝/ml比例、HBeAg血清学转换率和耐药发生率的预测价值。方法观察189名慢性乙型肝炎患者使用拉米夫定,100mg/d,口服。根据12周血清HBV DNA<103拷贝/ml或≥103拷贝/ml将患者分为A、B组,继续治疗至96周。分别于0、4、12、24、36、48、60、72、84、96周检测血清HBV DNA定量、HBV血清标志物。分析96周时2组疗效的差异。结果该组病例189例在治疗4周、12周、24周HBV DNA达到检测线以下分别61、117、124人(百分比分别为32.27%、61.91%、65.61%),且96周时仍维持在检测水平以下者比例均在70%以上。治疗4周时已达HBV DNA<103拷贝/ml患者突破反弹者为21.74%,≥103拷贝/ml为61.67%;治疗12周时达到HBV DNA定量检测水平以下者或仍≥103拷贝其后发生HBV DNA分别为27.35%,75.00%;24周分别为28.23%,69.81%。A组96周时血清HBV DNA<103拷贝/ml比例为70.09%,高于B组(22.22%);HBeAg血清学转换率A组为63.89%、B组为16.39%;酪氨酸-蛋氨酸-天门冬氨酸-天门冬氨酸(YMDD)变异率A组为4.27%小于B组(12.50%)。结论使用拉米夫定治疗慢性乙型肝炎,12周时HBV DNA<103拷贝/ml可以预测96周疗效,减少耐药发生。
Objective To investigate the predictive value of quantitative HBV DNA test of lamivudine for 12 weeks in patients with chronic hepatitis B (HBcAg seroconversion rate and the incidence of drug resistance) after treatment with 96-week HBV DNA (103 copies / ml). Methods 189 patients with chronic hepatitis B were treated with lamivudine, 100mg / d orally. Patients were divided into groups A and B according to 12 weeks of serum HBV DNA <103 copies / ml or> 103 copies / ml, and the treatment was continued until 96 weeks. Serum HBV DNA, serum HBV markers were detected at 0, 4, 12, 24, 36, 48, 60, 72, 84 and 96 weeks respectively. Analysis of 96 weeks difference between the two groups of efficacy. Results 189 patients in this group had 61,117,124 HBV DNA (the percentages were 32.27%, 61.91%, 65.61%, respectively) after reaching the detection line at 4 weeks, 12 weeks and 24 weeks, and remained at 96 weeks Detection level below the proportion of more than 70%. At the 4th week of treatment, HBV DNA <103 copies / ml reached 21.74%, and ≥103 copies / ml reached 61.67%. After 12 weeks of treatment, HBV DNA below the level of quantitative detection or still ≥103 copies occurred HBV DNA were 27.35% and 75.00%, respectively, and they were 28.23% and 69.81% respectively at 24 weeks. The serum HBeAg seroconversion rate in group A was 63.89% in group A and 16.39% in group B at the age of 96 weeks in group A, which was lower than that in group B (70.09% Aspartate - Aspartate (YMDD) mutation rate in group A was 4.27% less than in group B (12.50%). Conclusions With lamivudine in the treatment of chronic hepatitis B, HBV DNA <103 copies / ml at 12 weeks can predict the efficacy of 96 weeks and reduce the occurrence of drug resistance.