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目的探讨拉米夫定(lamivudine,LMV)耐药慢性乙型肝炎(chronic hepatitis B,CHB)患者在联合阿德福韦(adefovir,ADV)用药后,血清HBsAg的变化对预测治疗反应的意义。方法筛选78例2012年3月—2014年12月在首都医科大学附属北京佑安医院收入的LMV耐药CHB患者,收集其一般人口学资料及临床资料,检测LMV-ADV联合用药后6个月时血清HBsAg和HBV DNA水平的变化。根据病毒学应答(virological response,VR)分成两组,即病毒学应答VR(+)组(50例)和无病毒学应答VR(-)组(28例)。分析HBsAg水平和治疗效果的关系。结果联合治疗前,患者血清HBsAg和HBV DNA在VR(+)组和VR(-)组间差异无统计学意义(P>0.05),联合用药后,患者血清HBsAg和HBVDNA都呈现出下降趋势。6个月后,50例获得病毒学应答,包括HBeAg阳性组20例和全部HBeAg阴性组30例。HBeAg阴性的LMV耐药患者通过联合用药全部达到了病毒学应答。对HBeAg(+)组患者进一步分析,分为VR(-)组和VR(+)组,结果显示,两小组的HBsAg水平随着联合用药时间延长都呈下降趋势,在治疗6个月时差异有统计学意义(P<0.05)。结论血清HBsAg水平有助于预测LMV-ADV联合用药对LMV耐药CHB患者的治疗反应。
Objective To investigate the significance of the change of serum HBsAg in predicting response to treatment with lamivudine (LMV) in patients with chronic hepatitis B (CHB) after adefovir (ADV). Methods Seventy-eight LMV-resistant CHB patients from March 2012 to December 2014 in Beijing You’an Hospital of Capital Medical University were enrolled in this study. Their demographic and clinical data were collected. Six months after the combination of LMV-ADV Changes of serum HBsAg and HBV DNA levels. According to the virological response (VR), the patients were divided into two groups: the virologic response VR (+) group (50 cases) and the virological response VR (-) group (28 cases). Analyze the relationship between HBsAg level and therapeutic effect. Results Before treatment, there was no significant difference in serum HBsAg and HBV DNA levels between VR (+) group and VR (-) group (P> 0.05). After combined treatment, serum HBsAg and HBVDNA showed a decreasing trend. Six months later, 50 patients received virological responses, including 20 in the HBeAg-positive group and 30 in the complete HBeAg-negative group. HBeAg-negative LMV-resistant patients all achieved virological response through combination therapy. The HBeAg (+) patients were further divided into the VR (-) group and the VR (+) group. The results showed that the levels of HBsAg in both groups showed a downward trend with the prolongation of the combination therapy, and the difference was significant at 6 months There was statistical significance (P <0.05). Conclusions Serum HBsAg level is helpful to predict the response of LMV-ADV combination therapy to LMV-resistant CHB patients.