拉米夫定联合疗肝3号对乙型肝炎病毒YMDD变异的影响和机制分析.docVIP

拉米夫定联合疗肝3号对乙型肝炎病毒YMDD变异的影响及机制分析 　　作者：涂燕云，张红星，陈枝俏，蒋阳昆，林海 作者单位：广西中医学院附属瑞康医院肝胆内科，广西，南宁，530011 　　【摘要】 目的 观察拉米夫定联合疗肝3号对乙型肝炎病毒YMDD变异的影响。方法 将80例慢性乙型肝炎(CHB)患者随机分为治疗组和对照组，治疗组40例为联合应用拉米夫定和疗肝3号;对照组40例为单用拉米夫定，疗程均为18个月，每3个月分别检测肝功能、乙型肝炎病毒血清学标志物、HBV DNA、YMDD变异株、T淋巴细胞亚群。结果 在治疗12个月时，治疗组出现2例(5.00%)变异，对照组5例(12.50%)，差异无显著性(P0.05);在治疗18个月时，治疗组出现4例(10.00%)变异，对照组12例(30.00%)，差异有显著性(P0.05)。停药6个月后治疗组在HBV-DNA阴转、HBeAg/抗-HBe血清转换、HBeAg阴转上明显优于对照组(P均0.05)。治疗组外周血CD4+亚群水平上调，CD4+/CD8+比值趋于正常，停药6个月后仍持续保持高水平，与对照组比较差异有高度显著性(P均0.01)。结论 拉米夫定联合疗肝3号有调节CHB患者细胞免疫水平的作用，可减少YMDD变异的发生。 　　【关键词】 肝炎 乙型 慢性 基因变异 拉米夫定 疗肝3号 　　Lamivudine in combination with Liaogansanhao in treatment of patients with chronic hepatitis B and its effects on YMDD variants 　　TU Yan-yun, ZHANG Hong-xing, CHEN Zhi-qiao, JIANG Yang-kun, LIN Hai 　　(Internal Hepatobiliary Department, Affiliated Ruikang Hospital to Guangxi TCM University, Nanning, Guangxi 530011, China) 　　Abstract: Objective To observe the effects of traditional Chinese medicine Liaogansanhao in combination with lamivudine in treatment of patients with chronic hepatitis B (CHB) and its effects on YMDD variants. Methods 80 patients were enrolled and randomized into two groups: the treated group of 40 cases, treated with Liaogansanhao in combination with lamivudine; the control group of 40 cases, treated with lamivudine alone. One cycle lasted for 18 months, every 3 months, the liver function, virological markers of HBV, serum HBV DNA, YMDD variants and T-cell subpopulation were determined. Results At the end of 12-month treatment, 2 cases (5.00%) in the treated group and 5 cases (12.50%) in the control group with YMDD variants were observed, there was no statistical difference (P0.05). At the end of 18-month treatment, 4 cases (10.00%) with YMDD variants were observed in the treated grup and was significantly less than the control group, 12 cases (30.00%), P0.05. Six months after treatment, HBV-DNA-negative rate, HbeAg/anti-HBe negative and HBeAg negative ra