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目的:观察比较拉米夫定联合IFNα-1b的序贯疗法与拉米夫定、IFNα-1b的单药疗法在治疗HBeAg阳性的慢性乙型肝炎方面的疗效差异。方法:将98例HBeAg阳性慢乙肝患者随机分为序贯治疗组、拉米夫定治疗组和IFNα-1b治疗组。序贯治疗组33例,年龄37.85±7.70岁,男/女:18/15,首先使用拉米夫定(100mg一日一次口服疗程24周),序贯使用IFNα-1b(60ug隔日一次皮下注射疗程28周),在第20周至24周同时使用拉米夫定和IFNα-1b,总疗程48周;拉米夫定治疗组34例,年龄39.42±6.88岁,男/女:20/14,仅口服拉米夫定,100mg一日一次口服,疗程48周;IFNα-1b治疗组31例,年龄35.71±6.14岁,男/女:14/17,仅皮下注射IFNα-lb,60ug隔日一次,疗程48周。治疗12周、24周、48周时检测肝功能、乙肝两对半、HBV-DNA等指标变化。结果:在治疗12周、24周时三组间肝功复常率、HBeAg阴转率无差异,序贯治疗组、拉米夫定组HBV-DNA阴转率优于IFNα-1b治疗组;实验疗程结束时序贯治疗组HBeAg阴转率、抗-HBe转换率及HBV-DNA阴转率显著高于其他两组,P<0.05,但在HBV-DNA阴转率方面序贯治疗组与拉米夫定治疗组差异不显著。结论:拉米夫定和IFNα-lb序贯疗法在HBV-DNA阴转率、HBeAg阴转率和抗HBe转换率三方面的疗效优于拉米夫定、IFNα-lb单一用药。
OBJECTIVE: To compare the efficacy of sequential therapy with lamivudine and IFNα-1b compared with lamivudine in combination with IFNα-1b in the treatment of HBeAg-positive chronic hepatitis B. Methods: Ninety-eight HBeAg-positive chronic hepatitis B patients were randomly divided into sequential treatment group, lamivudine treatment group and IFNα-1b treatment group. A sequential treatment group of 33 patients aged 37.85 ± 7.70 years, male / female: 18/15, the first use of lamivudine (100mg once daily oral treatment for 24 weeks), sequential use of IFNα-1b (60ug every other subcutaneous injection The course of treatment was 28 weeks), and lamivudine and IFNα-1b were used simultaneously for the first 20 weeks to the second 24 weeks. The total course of treatment was 48 weeks. In the lamivudine group, 34 cases were 39.42 ± 6.88 years old, 20/14 male / Only oral lamivudine, 100mg once a day orally for 48 weeks; IFNα-1b treatment group of 31 patients, age 35.71 ± 6.14 years, male / female: 14/17, only subcutaneous IFNα-lb injection, 60ug every other day, Treatment for 48 weeks. Treatment of 12 weeks, 24 weeks, 48 weeks detection of liver function, hepatitis B two and a half, HBV-DNA and other indicators change. Results: At 12 and 24 weeks of treatment, there was no difference in the rate of abnormal liver function and HBeAg negative conversion between the three groups. The negative conversion rate of HBV-DNA in sequential therapy group and lamivudine group was better than IFNα-1b treatment group. At the end of the experimental course, HBeAg negative rate, anti-HBe conversion rate and HBV-DNA negative rate in sequential therapy group were significantly higher than those in the other two groups (P <0.05). However, in sequential treatment group with HBV-DNA negative conversion rate There was no significant difference in the mifuding treatment group. Conclusions: Lamivudine and IFNα-1b sequential therapy is superior to lamivudine and IFNα-1b single-dose in three aspects: HBV DNA negative rate, HBeAg negative rate and anti-HBe conversion rate.