摘要
目的探讨拉米夫定、替比夫定抗乙型肝炎病毒(HBV)过程中对患者血清生化学、病毒学及组织学的影响。方法选取35例慢性乙型病毒性肝炎(乙肝)患者,将患者随机分为拉米夫定组(19例)和替比夫定组(16例),分别口服拉米夫定和替比夫定治疗104周。定期检查两组患者的血清门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)水平,HBV DNA定量,并在治疗前和治疗52周时进行肝穿刺活检,比较肝脏组织学变化。结果 (1)替比夫定组治疗52周时AST复常率(75.0%)、治疗104周时的HBeAg阴转率(56.3%)及治疗52周时的疗效反应率(81.2%)、病毒应答率(56.3%)均显著高于拉米夫定组(分别为36.8%、21.1%、36.8%和21.1%),差异均有统计学意义(P<0.05);而治疗24、52、104周时HBV DNA阴转率(分别为50.0%、62.5%、50.0%)与拉米夫定组(分别为36.8%、47.3%和31.6%)比较,差异无统计学意义(P>0.05)。(2)两组患者治疗24周时HBV DNA均较基线显著降低,差异有统计学意义(P<0.01),但两组间差异无统计学意义(P>0.05);治疗52周和104周时,替比夫定组患者HBV DNA下降量较拉米夫定组更为明显,差异有统计学意义(P<0.05)。(3)拉米夫定组和替比夫定组治疗52周时肝脏纤维化(S)的减轻程度与基线比较,差异有统计学意义(P值分别为0.0437和0.009);但两者间比较差异无统计学意义(P>0.05)。拉米夫定组患者治疗52周时肝脏炎症(G)减轻程度与基线比较,差异无统计学意义(P>0.05);但替比夫定组治疗52周时肝脏炎症(G)减轻程度与基线比较,差异有统计学意义(P<0.05),且替比夫定组与拉米夫定组比较,其肝脏炎症(G)减轻程度更显著(P<0.05)。结论替比夫定较拉米夫定具有更强、更持久的抑制HBV DNA复制的能力、较少的耐药率和病毒反跳率,且能更好地改善肝脏炎症。
Objective To study the effect of lamivudine and telbivudine on biochemistry,virology and hepatohistology in hepatitis B antiviral treatment.Methods Patients with chronic hepatitis B were randomized into lamivudine group（19 cases） and telbivudine group（16 cases）,with each group taking lamivudine or telbivudine per os for 104 weeks.AST,ALT,and HBV DNA quantification were examined periodically and changes in hepato-histology before treatment and at week 52 were compared.Results Telbivudine group showed a significant higher rate of ALT normalization（75.0%）,therapeutic response（81.2%）,viral response（56.3%） at week 52 and a significantly higher rate of HBeAg negative conversion（56.3%） at week 104 compared with lamivudine group（36.8%,36.8%,21.1% and 21.1%,respectively,P〈0.05）.At week 24,52 and 104,the HBV DNA negative conversion rates of telbivudine group（50.0%,62.5% and 50.0%,respectively） had no statistical difference compared with that of the lamivudine group（P〉0.05）;HBV DNA level was both significantly reduced at week 24 in the two groups（P〈0.01）,but there was no statistical difference between the two groups（P〉0.05）;Telbivudine group reduced greater in HBV DNA at week 52 and 104 than lamivudine group,the difference between the two groups was significant（P〈0.05）.In both two groups,hepatic fibrosis（S） at week 52 was relieved significantly compared with baseline（with P valued 0.0437 and 0.009,both〈0.05） in lamivudine and telbivudine respectively.However,there was no statistical difference between the two groups（P〉0.05）.At week 52,significant improvement in hepatic inflammation（G） compared with baseline was seen in telbivudine group（P〉0.05）,while there was no significant improvement in lamivudine group（P〈0.05）.Telbivudine exhibited more significant improvement in hepatic inflammation（G） than lamivudine（P〈0.05）.Conclusion Telbivudine is superior to lamivudine in the inhibition of HBV DNA replication,drug resistance rate,rebound of viral replication rate and the improvement of liver tissues.
出处
《中国全科医学》
CAS
CSCD
北大核心
2010年第36期4069-4071,共3页
Chinese General Practice
