【作者】 沈秀娟；

【导师】 甘建和；

【作者基本信息】 苏州大学 ， 内科学， 2002， 硕士

【摘要】 目的：探讨干扰素联合拉咪呋啶治疗慢性乙型肝炎的抗HBV的治疗效果。方法：将142例血清HBeAg、HBV-DNA阳性慢性乙型肝炎患者随机分成四组：干扰素治疗组（A组）35例，拉咪呋啶治疗组（B组）38例，干扰素联合拉咪呋啶治疗组（C组）29例，一般疗法组（D组）40例。检测治疗1年后血清HBeAg及HBV-DNA阴转率及动态变化、肝功能ALT好转率及动态变化、外周血CD₄⁺，CD₄⁺／CD₈⁺变化、观察肝组织学变化、不良反应等，探讨干扰素联合拉咪呋啶治疗慢性乙型肝炎的抗HBV的治疗效果。结果：干扰素组、拉咪呋啶组、干扰素联合拉咪呋啶组及一般疗法组的HBeAg阴转率分别为20.00％、15.79％、34.48％和2.50％；血清HBV-DNA阴转率分别为37.14％、55.26％、65.52％和0.00％；肝功能ALT。复常率分别为40.00％、60.53％、72.41％和10.00％。在HBeAg阴转率方面，干扰素组、干扰素联合拉咪呋啶组的疗效明显优于一般疗法组（P＜0.05）。在血清HBV-DNA阴转率方面，干扰素组、拉咪呋啶组、干扰素联合拉咪呋啶组的疗效明显优于一般疗法组（P＜0.05），拉咪呋啶组干扰素联合拉咪呋啶组的疗效明显优于干扰素组（P＜0.05）。在肝功能ALT.复常率方面，干扰素组、拉咪呋啶组、干扰素联合拉眯呋啶组的疗效明显优于一般疗法组（P＜0.05），干扰素联合拉咪呋啶组的疗效明显优于干扰素组（P＜0.05）。 干扰素联合拉咪呋啶组治疗后外周血CD₄⁺／CD₈⁺比值较治疗前明显提高（P＜0.05）。当血清HBV-DNA＜100Pg／ml时，分析血清HBV-DNA阴转率，干扰素联合拉咪呋啶组疗效优于单用干扰素组（P＜0.05）；分析血清HBeAg阴转率，干扰素联合拉咪呋啶组疗效优于单用拉咪呋啶组（P＜0.05）。干扰素联 干扰素联合拉眯吠陡治疗慢性乙型肝炎的抗HBV的疗效的临床研究 提要 合拉咪吱碗治疗慢性乙型肝炎未见明显增加不良反应的发生率。结 论：干扰素联合拉眯吱咤对慢性乙型肝炎的抗病毒治疗是有效的、安 全的，尤其适合于血清HBVlNA＜100Pg／ml的患者。更多还原

【Abstract】 [Objective]To evaluate the therapeutic efficacy of interferon combinated lamivudine and interferon or lamivudine monotherapy in patients with chronic hepatitis B [Methods] 142 patients with chronic hepatitis B wliose HbeAg HBV-DNA were positive were chosen according to the standard criterion and randomly divided into 4 groups:35 patients were treated with interferon for 4 months (A group) ,38 patients were treated with lamivudine at least 1 year(B group), 29 patients were treated with interferon combinated lamivudine in the same ways(C group),40 patients were treated with Ganlixin and ChuiPengChao as control(D group). We tested the response rates of serum HBV-DNA and HBeAg. the ALT normalization rate the growth of CD4+/ CD? in peripheral blood of every group after 1 year. We observed the histological improvement of the liver before and after therapy and the adverse events. [Results] The response rate of serum HBeAg of A group B group C group and D group were 20.00% 15.79% 34.48%and2.50% respectively,it was significantly greater of A group and C group than of D group respectively.The response rate of serum HBV-DNA of those four groups were 37.14% 55.26% 65.52 %andO.OO% respectively,it was significantly greater of A group B group and C group than of D group respectively,and was significantly greater of B group and C group than of A group respectively.The ALT normalization rate of those four groups were 40.00 % 60.53 % 72.41% and 10.00%respectively, it was significantly greater of A group> B group and C group than of D group respectively, and was significantly greater of C group than of A group. The response rate of HBV-DNA was significantly greater to interferon combined lamivedine than to interferon monotherapy and the response rate of HBeAg is significantly greater to interferon combined lamivedine than to lamivudine monotherapy among patients with low level viremia (HBV-DNA<100pg/ml). The growth of CD4+/ CD8+ is significantly greater to interferon combinated lamivudine than to interferon or lamivudine monotherapy . Meanwhile,liver boipy was done in 1 patient before and after the treatment with interferon combinated lamivudine, which showed obvious histological improvement. Combination therapy has not increased the rate of adverse events [Conclution] The therapeutic effective rate to interferon combined lamivudine is greater than interferon or lamivudinemonotherapy ,especially when whose serum HBV-DNA level was lower than 100pg/ml.更多还原