摘要
【目的】探讨慢性乙型肝炎患者拉米夫定耐药后出现肝功能衰竭的危险因素。【方法】拉米夫定耐药后导致病情加重的慢性乙型肝炎患者56例纳入研究,记录拉米夫定治疗前病程、诊断、拉米夫定疗程,检测并记录临床耐药时的肝功能、乙肝两对半、HBVDNA定量、YMDD变异及前C区变异。按病情加重后的诊断分为肝功能衰竭组和慢性乙型肝炎组进行比较。【结果】肝功能衰竭组患者年龄(45±13)岁,大于慢性乙型肝炎组(37±13)岁(P<0.05);肝功能衰竭组临床耐药时HBVDNA载量高于慢性乙型肝炎组[(2.8×108±4.9×108)拷贝/mLvs(3.1×106±2.9×106)拷贝/mL;P<0.05];肝功能衰竭组出现HBeAg/Anti-HBe血清学转换(54.6%)高于慢性乙型肝炎组(18.4%,P<0.05)。年龄和拉米夫定治疗前诊断为肝硬化都是耐药后出现肝功能衰竭的独立危险因素。【结论】拉米夫定治疗前年龄大、诊断为肝硬化,临床耐药时病毒载量高,耐药后出现HBeAg/Anti-HBe血清学转换可能是拉米夫定治疗耐药后出现肝功能衰竭的危险因素。有肝硬化基础患者一旦发生耐药变异,应及时使用能治疗耐药变异的阿德福韦或恩替卡韦。
[Objective] To investigate the risk factors of liver failure due to lamivudine resistance in the patients with chronic hepatitis B. [ Methods ] Fifty-six cases with acute exacerbation in chronic hepatitis B patients due to lamivudine resistance were investigated. The age and the diagnosis of the disease before lamivudine therapy, the liver function, HBsAg, HBsAb ,HBeAg,HBeAb ,HBcAb, HBV DNA load, the rate of YMDD mutation and preC mutation were also recorded. All cases were divided into liver function failure group and chronic hepatitis B group when flared, and each factor in the 2 groups was compared. [Results] The patients in liver function failure group were elder in age （P 〈 0.05）. The HBV DNA load detected when flared in liver function failure group were higher than those in chronic hepatitis B group [（2.8×10^8＋4.9×10^8 copies/mL vs （3.1×10^62.9×10^6） conpies/mL,P 〈 0.05 ]. The rate of HBeAg seroconversion in liver function group （54.6%） was higher than the rate in chronic hepatitis B group （18.4% ,P〈 0.05）. Analyzed with binary logistic regression, the age and the diagnosis as liver cirrhosis before lamivudine therapy were both the isolated risk factors of liver function failure due to lamivudine resistance. [ Conclusions ] Diagnosed as liver cirrhosis and aged before lamivudine therapy, high virus load when flared may be the risk factors of liver function failure due to lamivudine resistance in the patients with chronic hepatitis B. Early use of adefovir dipivoxil or entecavir should be considered in patients with pre-existing cirrhosis when they have resisted to lamivudine.
出处
《中山大学学报（医学科学版）》
CAS
CSCD
北大核心
2007年第6期706-708,共3页
Journal of Sun Yat-Sen University:Medical Sciences
基金
广东省科技计划项目(2005B31201004)
关键词
慢性乙肝
拉米夫定
停药耐药
肝功能衰竭
chronic hepatitis B
lamivudine
resistance
liver function failure
