摘要
目的 研究拉米夫定治疗慢性乙型肝炎时病毒发生ＹＭＤＤ变异对临床的影响及处理措施。方法 随机选择６６例病人用拉米夫定治疗（１００ｍｇ／ｄ）４８周，２０例病人服用安慰剂作对照共１２周，１２周结束后继续服用拉米夫定１００ｍｇ／ｄ共３６周。每隔４周检测一次血清ＨＢＶ ＤＮＡ、ＡＬＴ和ＹＭＤＤ变异，到治疗４８周为止。结果 治疗４８周结束时，共有１８例病人出现ＹＭＤＤ变异，变异率为２０．９％。其中２例在服药３６周时发生变异，其余１６例在服药４８周时发生。服药４８周时，变异者和非变异者的ＡＬＴ和ＨＢＶ ＤＮＡ的检测结果：变异者分别为（３６．２±４６．１）Ｕ／Ｌ和（１４．３ ± ２７．２）ｐｇ／ｍｌ，非变异者分别为（２０．４ ± １２．５）Ｕ／Ｌ和（２．５ ± ６．１）ｐｇ／ｍｌ，经Ｗｉｌｃｏｘｓｏｎ检验均有显著性差异（Ｐ＜０．０１）。发生变异的１８例病人继续服药，其中２例病人出现病情的急性发作，分别于８０周和９２周停药。经临床对症治疗，ＡＬＴ均恢复正常。其余１６例病人继续服药至１０４周。结论 拉米夫定治疗慢性乙型肝炎过程中，必须严密观察ＹＭＤＤ变异，一旦病人因ＹＭＤＤ变异出现病情急性发作，应停用拉米夫定。
Objective To study the clinical influence and management of chronic hepatitis B patients treated with lamivudine after emergence of YMDD motif mutation. Methods 66 patients received lamivudine 100 mg daily for 48 weeks and 20 patients received placebo 12 weeks and lamivudine 36 weeks respectively. Serum HBV DNA,ALT and YMDD mutation were assayed every 4 weeks up to 48 weeks. Results At the end of week 48, YMDD mutations developed in 18 patients, the mutation rate was 20.9%. YMDD mutations were detected in 2 patients at week 36, and 16 patients at week 48 .The serum ALT and HBV DNA levels in YMDD mutation patients were 36.2 ± 46. 1U/L and 14.3 ± 27.2pg/ml and those in non-mutation patients were 20.4 ± 12.5U/L and 2.5 ± 6.1pg/ml respectively(p<0.01). After the emergence of YMDD mutation, the patients were advised to continue to take lamivudine for 2 years. Clinical and biochemical flared-up occurred in 2 patients at week 80 and week 92. Then lamivudine was stopped and patients recovered normal. Conclusion Closely monitor YMDD mutation is necessary during lamivudine therapy and appropriately measures should be taken in those patients.
出处
《肝脏》
1999年第4期194-196,共3页
Chinese Hepatology
