拉米夫定与干扰素序贯治疗慢性乙型肝炎

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目的探索拉米夫定与干扰素治疗慢性乙型肝炎的最佳联合方案。方法选择HBsAg、HBeAg和HBV-DNA同时阳性的慢性乙型肝炎病例,随机分为三组,A组:单用干扰素500万U,肌肉注射,隔日一次,疗程6个月。B组:单用拉米夫定100mg,口服,每日一次,连用6个月。C组:先用拉米夫定100mg,口服,每日一次,两个月后加干扰素500万U肌肉注射,隔日一次,两药同时应用2个月后停拉米夫定,然后继续应用干扰素4个月。每组病例分别在治疗2个月、4个月、6个月和停药6个月时检测肝功能、乙肝五项指标和HBV-DNA。结果治疗2个月时转氨酶复常率和HBV-DNA阴转率B组和C组优于A组(p<0.01)。治疗4个月时e-抗原阴转率A组优于B组和C组(p<0.05)。治疗6个月时e-抗原阴转率A组和C组高于B组(p<0.05),HBV-DNA阴转率B组和C组优于A组(p<0.05)。停药6个月随访,B组转氨酶和HBV-DNA反跳率高于A组和C组(p<0.05)。结论拉米夫定发挥作用快,HBV-DNA转阴早,但停药后易反跳。干扰素发挥作用较慢,近期疗效不及拉米夫定,但远期疗效较好,停药后反复发率低。两药序贯治疗可弥补二者的不足,是一种比较理想的联合方法。 Objective To explore the best combination of lamivudine and interferon in the treatment of chronic hepatitis B. Methods Chronic hepatitis B patients with positive HBsAg, HBeAg and HBV-DNA were randomly divided into three groups. Group A: Interferon 5 million U was injected intramuscularly every other day for 6 months. Group B: Lamivudine alone 100mg, orally, once daily, once every 6 months. Group C: first with lamivudine 100mg, orally, once daily, after two months plus interferon 5000000 U intramuscular injection, once every other day, two drugs at the same time 2 months after stopping lamivudine, and then continue to use Interferon for 4 months. Each group of patients were tested for liver function, five indicators of hepatitis B and HBV-DNA in the treatment of 2 months, 4 months, 6 months and 6 months of withdrawal. Results At 2 months after treatment, the normal rate of aminotransferase and the negative rate of HBV DNA in groups B and C were better than those in group A (p <0.01). The e-antigen negative conversion rate in group A was better than group B and C at 4 months (p <0.05). The levels of e-antigen negative conversion in group A and C were higher than those in group B at 6 months (p <0.05), and the negative rates of HBV-DNA in group B and C were better than those in group A (p <0.05). After 6 months of follow-up, the rebound rate of transaminase and HBV-DNA in group B was higher than that in group A and C (p <0.05). Conclusion lamivudine play a fast role, HBV-DNA negative early, but easy to rebound after withdrawal. Interferon play a slower role, the recent efficacy is less than lamivudine, but long-term efficacy is better, after stopping the anti-recurrence rate is low. Sequential treatment of two drugs can make up for the lack of both, is an ideal combination method.
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