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目的 观察疗效确切的抗病毒药物和免疫调节剂 ,叠加伍用对慢性乙型肝炎病人HBV复制和变异的影响。方法 应用拉米夫定、干扰素α 2b、黄芪注射液三联叠加疗法 ,对慢性乙型肝炎病人进行抗病毒治疗 ,并与单独应用拉米夫定的抗HBV效果进行比较评价。检测HBVDNA阴转率和HBeAg 抗HBe血清转换率 ;血清HBVDNA浓度 ;HBVDNA的YMDD变异率和前C区变异率。结果 A组 (叠加用药组 )与B组 (拉米夫定单药组 )比较 ,HBVDNA阴转率分别在第 12周、36周及 48周差异有显著性 (P <0 0 5 ) ,HBeAg阴转率在第 36周、48周差异有显著性 (P <0 0 5 ) ,抗HBe阳转率仅在第 48周差异有显著性 (P <0 0 5 ) ;两组患者血清HBVDNA浓度比较 ,治疗 12周时降低程度差异有显著性 (P <0 0 5 ) ,治疗第 36周和 48周时差异有非常显著性 (P <0 0 1) ;治疗后 12周 ,A组出现前C区BCP变异 ;疗后 2 4周、36周和 48周 ,两组均出现YMDD和前C区变异。结论 与拉米夫定单独用药比较 ,三联叠加疗法可增加慢性乙型肝炎患者HBVDNA阴转率和HBeAg 抗HBe血清转换率 ,更显著降低血清HBVDNA浓度 ,并减少YMDD变异 ,故其抗HBV疗效优于拉米夫定单独用药。
Objective To observe the effect of antiviral drugs and immunomodulatory agents with exact therapeutic effects on HBV replication and mutation in patients with chronic hepatitis B. Methods Lamivudine, interferon α 2b and astragalus injection triple therapy were used to treat patients with chronic hepatitis B virus antiviral therapy, and compared with the anti-HBV effect of lamivudine alone. Detection of negative rate of HBVDNA and HBeAg anti-HBe seroconversion rate; Serum HBVDNA concentration; HBVDNA YMDD mutation rate and pre-C region mutation rate. Results Compared with group B (lamivudine monotherapy group), the negative conversion rates of HBVDNA in group A were significantly different at week 12, 36, and 48 (P <0.05), while HBeAg negative There was significant difference between the 36th week and the 48th week (P <0 05), while the positive rate of anti-HBe was only significant at the 48th week (P <0 05). The serum HBVDNA concentrations of the two groups were significantly higher than those of the control group , There was a significant difference in the degree of reduction at 12 weeks (P <0 05). There was a significant difference between the 36th week and the 48th week after treatment (P <0.01); at 12 weeks after treatment, the former C District BCP variation; After 24 weeks, 36 weeks and 48 weeks after treatment, both groups appeared YMDD and pre-C region variation. Conclusion Compared with lamivudine alone, triple superposition therapy can increase HBVDNA negative rate and HBeAg anti-HBe seroconversion rate in patients with chronic hepatitis B, significantly lower serum HBVDNA concentration and reduce YMDD mutation, so its anti-HBV efficacy Lamivudine alone medication.