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目的探讨拉米夫定在慢性乙肝中的应用。方法对180患者的临床资料进行回顾分析。结果治疗12个月后HBV-DNA阳性例数41例,两者比较差异有统计学意义(P<0.05)。治疗后第1年YMDD变异率为22.5%,被检测出YMDD变异的时间分别在12周(6例)、24周(21例)和48周(14例);120周时YMDD变异率分别为32%。在12周时检测出YMDD变异的6例患者HBeAg均未阴转,HBV-DNA为阳性,但维持在较低水平(<10万copies/ml);ALT亦维持在低水平(<2 U/L)。其他患者在治疗过程中HBV-DNA曾阴转,但YMDD变异时HBV-DNA全部反跳、ALT明显升。结论拉米夫定疗效确切,能迅速、有效抑制HBV复制,但不能完全清除病毒,停药后易复发;治疗过程中应严密监测YMDD病毒变异,防止发生肝功能失代偿。
Objective To investigate the application of lamivudine in chronic hepatitis B. Methods The clinical data of 180 patients were retrospectively analyzed. Results The positive cases of HBV-DNA in 12 months after treatment were 41 cases, the difference was statistically significant (P <0.05). The YMDD mutation rate was 22.5% in the first year after treatment, and the YMDD mutation time was detected in 12 weeks (6 cases), 24 weeks (21 cases) and 48 weeks (14 cases). The mutation rates of YMDD at 120 weeks were 32%. Six patients with YMDD mutation detected at 12 weeks had no negative HBeAg, HBV-DNA positive, but remained low (<100,000 copies / ml); ALT was also maintained at a low level (<2 U / L). Other patients in the course of treatment of HBV-DNA was overcast, but YMDD mutation HBV-DNA all rebound, ALT significantly increased. Conclusions Lamivudine has definite curative effect, can rapidly and effectively inhibit HBV replication, but can not completely remove the virus and is easy to relapse after stopping the treatment. During the treatment, the variation of YMDD virus should be closely monitored to prevent the occurrence of hepatic decompensation.