摘要
目的 观察慢性乙型肝炎病人出现YMDD变异后继续治疗的结果。方法 定期观察 44例出现YMDD变异后继续长期应用拉米夫定的慢性乙型肝炎病人 ,项目包括临床表现、ALT、SB、乙型肝炎病毒血清学标志、HBVDNA及YMDD变异情况。结果 88例病人服拉米夫定 3年 ,共有 5 1例出现YMDD变异。 48周、10 4周和 168周YMDD变异率分别为 2 1.7%、48%和 68.4%。 44例继续用药病人按变异后ALT的变化分为 3组 :ALT值 <1ULN(16例 )、>1～5ULN(2 1例 )和 >5ULN(7例 ) ;HBVDNA中位值分别为 0 .88、2 0 0 .93和 5 3 7.70mEq/ml;血清转换分别为 7、1和 1例。与无病毒变异组的血清转换率 61.1%相比 ,变异后ALT正常组为 43 .8% (P >0 .0 5 ) ,变异后ALT异常组为 7.1% (P <0 .0 1)。结论 拉米夫定对大多数YMDD变异的慢性乙型肝病人仍有效 。
Objective To investigate the efficacy and safety of long term lamivudine therapy after emergence of the YMDD mutation in patients with chronic hepatitis B. Methods 44 patients of YMDD mutation were received long term lamivudine therapy over one year. Clinical symptoms, ALT, SB, virological parameters, serum HBV DNA and YMDD mutations were evaluated. Results 88 patients with chronic hepatitis were treated with lamivudine for three years, YMDD mutations were occurred in 51 patients, the mutation rates were 21.7%, 48% and 68.4% at the week 48,104 and 168. 44 patients received long term lamivudine therapy after mutation. According to the changes of ALT after YMDD mutation, 44 patients were divided into three groups: ALT level<1×upper limit of normal (ULN) (16 cases), >1～5 ULN (21 cases) and >5ULN (7 cases) respectively, the median HBV DNA were 0.88, 200.93 and 537.70 mEq/ml, the numbers of HBeAg seroconversion were 7,1 and 1. The rate of HBeAg seroconversion in patients without YMDD mutation group was 61.1%, that compared with YMDD mutation and normal ALT level group was 43.8% ( P >0.05), when compared with elevated ALT level group, it was 7.1%( P <0.01). There was significant difference between two YMDD mutation groups ( P <0.01).Conclusion Long term lamivudine therapy was effective and safety in most patients with chronic hepatitis B after emergence of YMDD mutation, but close monitor would be necessary.
出处
《肝脏》
2002年第2期82-83,86,共3页
Chinese Hepatology
