摘要
目的:探讨苦参素治疗慢性乙型肝炎的疗效、安全性及影响应答反应的相关因素. 方法:采取回顾性分析方法,对203例单独接受苦参素治疗与109例接受苦参素联合拉米夫定治疗的慢性乙型肝炎患者的临床资料进行回顾性分析,观察应答反应情况及影响应答反应的相关因素. 结果:312例患者完全应答率(CR)为36.5%,持续应答(SR)率32.4%;恶化率8.0%;基线ALT<1 334nkat/L、1 334 nkat/L≤ALT<3 335 nkat/L、3 335 nkat/L ≤ALT<6 670 nkat/L及ALT≥6 670 nkat/L的患者CR 和SR分别为21.4%,33.8%,39.7%及59.5%和14.3%, 31.6%,38.5%及47.6%(P=0.0 012和0.0 027); HBVDNA<108copies/L、108copies/L≤HBVDNA≤1011copies/L及HBVDNA>1011copies/L的患者完全应答和持续应答率分别为57.9%,37.4%及26.5%和50.0%, 28.9%及8.2%(P=0.0 262和0.0 070);苦参素治疗乙肝疗程以6 mo时应答反应率最高,延长疗程应答率进一步提高有限;联合拉米夫定治疗的患者完全应答和持续应答率分别为46.8%和41.3%高于单用苦参素的31.0% 和27.6%(P=0.0 048和0.0 020),而恶化病例发生率明显低于单用苦参素组(11.3% vs 1.8%,P=0.0 009). 结论:苦参素治疗慢性乙型肝炎有肯定的疗效,应答反应随基线ALT水平的升高而升高,而与治疗前HBV DNA水平呈负相关;苦参素单用治疗乙肝部分病例可发生病情恶化,联合拉米夫定治疗可提高应答反应率并降低恶化病例的发生率.
AIM: To evaluate the efficacy and safety of Oxymatrine in the treatment of chronic hepatitis B. METHODS: Patients treated with Oxymatrine (n = 203) or with the combination of Oxymatrine and Lamivudine (n = 109) were retrospectively studied. The therapeutic response and the affecting factors were analyzed. RESULTS: Of the 312 patients, complete response (CR) rate, sustained response (SR) rate and exacerbation (EB) rate were 36.5%, 32.4% and 8.0%, respectively. The CR and SR rates of the patients with baseline ALT<1 334 nkat/L (upper normal limit), 1 334 nkat/L≤ALT<3 335 nkat/L, 3 335 nkat/L≤ALT<6 670 nkat/L and ALT≥6670 nkat/L were 21.4%, 33.8%, 39.7% and 59.5%, 14.3%, 31.6%, 38.5% and 47.6%, respectively (P= 0.0 012 and 0.0 027 for CR and SR, respectively); The CR and SR rates of the patients with HBV DNA<108copies/L, 108 copies/L≤HBV DNA≤1011 copies /L, and HBV DNA >1011 copies /L were 57.9%, 37.4% and 26.5%, 50.0%, 28.9% and 8.2%, respectively (P = 0.0262 and 0.0070 for CR and SR, respectively). The highest response occurred 6 months after treated with Oxymatrine, and further treatment did not yield higher response rate. The treatment with the combination of Oxymatrine and lamivudine led to higher CR, SR rates and lower EB rate than with Oxymatrine alone (46.8%, 41.3%, 1.8% vs 31. 0%, 27.6%, 11.3%, P = 0.0 048, 0.0 020, 0.0 009, respectively). CONCLUSION: Oxymatrine is safe and effective in the treatment of chronic hepatitis B. The response rates are positively correlated with base-line ALT level, but negatively correlated with HBV DNA level before treatment. Combination with lamivudine can increase the response rate and reduce the exacerbation rate.
出处
《世界华人消化杂志》
CAS
北大核心
2005年第3期317-320,共4页
World Chinese Journal of Digestology
