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Clinical outcome of long term Lamivudine therapy in patients with chronic HBV infection
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摘要: 目的研究拉米夫定优化治疗慢性HBV感染人群的可行性。方法选2002年9月～2006年8月期间216例慢性HBV感染患者,其中慢性肝炎112例,肝炎肝硬化104例。按HBeAg情况分为HBeAg（+）组和HBeAg（-）组。两组均给予拉米夫定100 mg/d,口服。末次观察时间为2009年8月。观察两组患者的HBVDNA应答时间与未来发生耐药的关系。结果 216例患者治疗36～84月,平均（61±9.8）月。治疗2周HBVDNA即检测不出的患者,5年发生病毒学突破率和临床耐药率均为0%,其中HBeAg（+）组患者的HBeAg 5年血清转换累积率为62.5%;治疗3～4周HBVDNA检测不出的HBeAg阳性患者,5年发生病毒学突破率为9.1%,临床耐药率为4.5%,HBeAg血清转换率为45.5%;而治疗3～4周HBVDNA检测不出的HBeAg阴性患者,5年发生病毒学突破率和临床耐药率均为0;在治疗5～8周、9～12周、13～24周等不同时间HBVDNA检测不出的两组患者,以后发生病毒学突破率分别为52.4%vs 41.2%、71.4%vs 66.7%和100%vs 100%（P<0...Abstract: Objective To evaluate the optimum treatment outcome in chronic HBV patients treated with Lamivudine.Meth-ods A total of 216, 114 chronic hepatitis B and 94 cirrhotic, patients were included in the study.The patients were divid-ed into HBeAg positive group (122 patients) and HBeAg negative group (94 patients) .All patients were treated with Lamivudine 100mg once daily for 36-84 months (61 ± 9.8 months on average) .Liver function tests, HBVDNA level, HBeAg sero conversion, serological markers and genetic variations were analyzed.Results No viral breakthrough and viral mutation was seen within 5 years among patients who had undetectable HBVDNA at the second week of treatment.The HBeAg serum conversion rate of was 62.5% in both groups during the 5 years of treatment.HBVDNA level was undetect-able after 3-4 weeks of treatment.The rate of viral breakthrough was 9.1% and the rate of HBeAg serum conversion was 45.5% in HBeAg positive group, and there was no viral breakthrough in HBeAg negative group.The virologic response and the viral breakthrough in both groups at 5-8weeks, 9-12 weeks, and 13-24 weeks were 52.4% vs 41.2%, 71.4% vs 66.7%, and 100% vs 100%, respectively during the 5 years of treatment. (P < 0.05) Conclusion A 4 week virologic response might be used to predict drug resistance and the long term effect of Lamivudine therapy in patients with chronic hepatitis B infection.It could also be used for choosing the appropriate patients to be treated with lamivudine effectively.
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Key words:
- hepatitis B /
- chronic
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