聚乙二醇干扰素α-2a联合阿德福韦酯治疗HBeAg阴性慢性乙型肝炎的临床研究

目的 探讨聚乙二醇干扰素(Peg-IFN) α-2a联合阿德福韦酯(ADV)治疗HBeAg阴性慢性乙型肝炎(CHB) 96周的疗效及安全性. 方法 25例初治HBeAg阴性CHB患者接受Peg-IFN α-2a(135μg/周或180μg/周)联合ADV (10 mg/d)治疗.96周治疗结束时,如获得HBsAg血清学转换则停药随访,否则停用Peg-IFN α-2a,继续ADV维持治疗.所有患者随访至120周.基线和治疗过程中每12周检测HBV DNA和HBsAg水平.计数资料采用x2检验或Fisher's exact test检验. 结果 Peg-IFNα-2a联合ADV治疗48周时,100％ (25/25)的患者HBV DNA低于检测值(＜ 500拷贝/ml),且在治疗过程中始终保持不可检测水平;治疗48周时HBsAg血清学转换率为12％ (3/25),96周上升至28％ (7/25).随访至120周,HBsAg血清学转换率为32％ (8/25).延长治疗至96周未见新的不良反应发生,其安全性同48周.结论 Peg-IFNα-2a联合ADV并延长疗程可显著提高HBeAg阴性CHB患者的抗病毒疗效,尤其可以提高HBsAg血清学转换率,是值得探索的优化治疗策略之一.     

序贯聚乙二醇干扰素α-2a治疗恩替卡韦经治未达满意终点乙型肝炎的疗效

目的 评估序贯聚乙二醇干扰素(Peg-IFN)α-2a治疗恩替卡韦经治HBeAg阳性慢性乙型肝炎的疗效与安全性.方法 57例恩替卡韦治疗96周达到HBV DNA＜500拷贝/ml且0.227PEIU/ml＜HBeAg≤50.000 PEIU/ml的HBeAg阳性慢性乙型肝炎患者,27例接受ETV与PegIFN α-2a联合治疗12周后改为Peg-IFN α-2a单药治疗至48周(试验组),30例继续接受恩替卡韦治疗48周(对照组),分别在治疗的24、48周进行生物化学、病毒学、血清学评估.统计学处理用t检验或x2检验.结果 试验组与对照组基线ALT、HBsAg、HBeAg水平有可比性.治疗48周,试验组HBeAg阴转率与HBeAg血清学转换率分别为40.7％和37.0％,与对照组的16.7％和13.3％相比,差异有统计学意义(x2值分别为4.079和5.11,P值均＜0.05).试验组HBsAg清除率和HBV DNA反弹率分别7.4％与11.1％,对照组无HBsAg清除和HBV DNA反弹(x2值分别为2.307 和3.519,P值均＞0.05).治疗48周,试验组HBsAg水平明显低于对照组[(2866.0±2580.4)IU/ml对比(4335.8±2650.0) IU/ml,t=5.11,P＜0.05]. 结论 恩替卡韦经治的HBeAg阳性慢性乙型肝炎患者,序贯Peg-IFNα-2a治疗有助于实现HBeAg血清转换和HBsAg定量下降.     

肝脏病理学特征对聚乙二醇干扰素α治疗HBeAg阳性慢性乙型肝炎患者HBeAg血清学转换的影响

目的 探讨聚乙二醇干扰素α治疗HBeAg阳性慢性乙型肝炎患者的疗效及肝脏病理学特征等因素对HBeAg血清学转换的影响. 方法 80例HBeAg阳性慢性乙型肝炎患者治疗前均行肝穿刺术,皮下注射Peg-IFN α,每周1次,治疗48周,随访24周.治疗结束后统计HBeAg的血清学转换情况,并结合肝脏病理学特征及性别、年龄、ALT、HBeAg半定量、HBV DNA定量等基线指标分析影响HBeAg血清学转换的相关因素.用多变量二分类logistic回归分析方法分析HBeAg血清学转换的影响因素. 结果 80例患者治疗48周时血清学转换率为30.00％ (24/80),其中22例肝组织炎症活动度为G1,HBeAg血清学转换率为9.09％;38例为G2,HBeAg血清学转换率为31.58％;19例为G3,HBeAg血清学转换率为47.3％;1例为G4,HBeAg成功转换.随着炎症活动度的升高,HBeAg血清学转换率逐步升高(x2=8.435,P=0.015);而肝组织纤维化程度与HBeAg血清学转换率无显著相关性(x2=5.917,P=0.116).性别、年龄、ALT、HBV DNA等基线指标在HBeAg 血清学转换组与未转换组的差异无统计学意义(P值均＞0.05).多变量二分类logistic回归分析结果显示,诸因素中仅肝组织炎症活动度(G)与HBeAg半定量为疗效影响因素.结论 HBeAg阳性慢性乙型肝炎肝组织炎症活动度高者聚乙二醇干扰素α治疗HBeAg血清学转换率较高,建议对需要治疗的患者应尽可能先行肝活组织检查.     

聚乙二醇化干扰素治疗乙型肝炎病毒e抗原阳性慢性乙型肝炎患者乙型肝炎病毒表面抗原消失的相关因素

目的 探讨聚乙二醇化干扰素（PEG-IFN α-2a）治疗HBeAg阳性慢性乙型肝炎(CHB)患者过程中预测HBsAg消失的相关因素。方法 对72例HBeAg阳性CHB患者,应用PEG-IFN α-2a 180 μg,每周1次,共48周。每3个月检测ALT、AST及HBV DNA、HBeAg和H BsAg定量,对48周治疗结束时HBsAg消失与基线、12周、24周的HBV DNA、HBeAg和HBsAg定量的相关关系进行分析。计数资料行Fisher精确检验及受试者工作特征(ROC)曲线分析。结果65例HBeAg阳性CHB患者完成本研究,其中7例HBsAg消失。48周时HBsAg的消失与治疗12周时H BeAg水平有关（Fisher确切概率法,P=0.023）,与治疗24周时HBeAg水平高度相关 （Fisher确切概率法,P=0.004）,与12周或24周时HBsAg＜250 IU/mL相关(Fisher确切概率法,P=0.001,P=0.002)。与12周时HBV DNA阴转相关（Fisher确切概率法,P=0.039）,而与24周时HBV DNA是否阴转无关（Fisher确切概率法,P= 0.130）。经ROC曲线分析显示,12周、24周HBsAg及24周HBeAg曲线下面积(AUC)分别为0.8584(P=0.0021)、0.9606(P=0.001)及0.8350(P=0.040)。结论 联合应用24周HBeAg和HBsAg定量水平可能是预测48周疗程结束时是否发生HBsAg消失的有效指标。     

肝脂肪变对慢性乙型肝炎患者聚乙二醇干扰素α治疗临床疗效的影响

目的 探讨肝脂肪变对聚乙二醇干扰素α (Peg-IFNα)治疗慢性乙型肝炎(CHB)患者临床疗效的影响.方法　96例HBeAg阳性CHB初治患者,经肝活组织检查证实合并肝脂肪变者34例(肝脂肪变组)、无肝脂肪变者62例(无肝脂肪变组),均用Peg-IFN α[治疗,疗程为48周,比较两组患者治疗结束时病毒学应答和生化学应答的差异.每组均数差异的比较采用t检验,率的比较采用x2检验.结果　HBV DNA滴度肝脂肪变组患者为(6.96±1.27) lg10拷贝/ml,无肝脂肪变组患者为(7.54±1.28) lg10拷贝/ml,两组比较,t=2.161,P=0.033,差异有统计学意义.Peg-1FN α[治疗48周时,HBeAg转换率、HBV DNA阴转率在肝脂肪变组分别为35.2％ (12/34)和44.1％ (15/34);无肝脂肪变组分别为38.7％ (24/62)和48.3％ (30/62),两组比较,差异无统计学意义.完全应答率在肝脂肪变组为26.5％,无肝脂肪变组为48.4％,两组比较,x2=4.373,P=0.037,差异有统计学意义.在45例HBV DNA转阴患者中,7例无生化学应答,其中肝脂肪变组有5例,无肝脂肪变组2例,无生化应答率肝脂肪变组显著高于无肝脂肪变组,P=0.032,差异有统计学意义. 结论 CHB患者合并肝脂肪变不影响Peg-1FN α[治疗48周时病毒学应答,但可能会影响其生化学应答.     

替比夫定治疗HBeAg阳性慢性乙型肝炎的疗效及相关预测因子的Logistic回归分析

目的观察替比夫定（LdT）治疗HBeAg阳性慢性乙型肝炎（CHB）患者3年的疗效,应用Logistic回归探讨HBeAg血清学转换的预测因子。方法收集58例采用LdT治疗的HBeAg阳性CHB患者,分析其性别、年龄、基线ALT水平、基线HBV DNA载量、基线HBeAg和HBsAg滴度与治疗3年时ALT复常率、HBV DNA阴转率、HBeAg阴转率和HBeAg血清转换率的相关性;采用Logistic回归分析HBeAg血清转换的相关因素。结果治疗3年时ALT复常率为84.48%,HBV DNA阴转率为70.69%,HBeAg阴转率为50.00%,HBeAg血清转换率为43.10%。与ALT≤2倍正常值上限（2×ULN）相比,基线ALT〉5×ULN的患者HBeAg转换率显著增高（P〈0.05）;与HBeAg≤100（S/CO）组相比,基线HBeAg〉200 S/CO的患者HBeAg的阴转率和血清转换率均显著下降（P〈0.05）;与HBV DNA≤6 log拷贝/ml组相比,HBV DNA〉7 log拷贝/ml的患者HBV DNA转阴率、HBeAg转阴率和HBeAg转换率下降显著（P〈0.05）;患者性别、年龄及基线HBsAg滴度对以上疗效指标无影响（P〉0.05）。多因素Logistic回归分析发现仅基线HBeAg滴度低的患者更易出现HBeAg血清学转换。结论 LdT能有效恢复肝功能,抑制HBV复制和提高HBeAg血清转换;基线HBeAg滴度可预测LdT治疗HBeAg阳性CHB患者的HBeAg血清转换率。     

慢性乙型肝炎患者HBeAg水平与恩替卡韦长期疗效的相关性

目的 了解慢性乙型肝炎患者HBeAg水平与恩替卡韦长期治疗效果的关系.方法 根据治疗前HBeAg水平,将59例慢性乙型肝炎患者分为3组:A组19例,HBeAg≥1000 s/co;B组20例,HBeAg为100～999 s/co;C组20例,HBeAg＜ 100 s/co.回顾性分析接受恩替卡韦治疗前HBeAg水平、治疗24周后HBeAg变化及其与144周疗效的关系.应用x2检验进行数据分析.结果 3组患者治疗前年龄、ALT水平的差异无统计学意义,而HBV DNA水平与HBeAg水平相关.59例患者治疗144周时ALT复常者58例(98.3％),HBV DNA水平达到检测限以下者56例(94.9％),HBeAg转阴30例(50.8％),HBeAg血清学转换26例(44.1％).3组患者ALT复常及HBV DNA转阴率的差异无统计学意义(x2=2.4146,P=0.3427;x2=2.2375,P=0.3267),而HBeAg转阴及血清学转换率的差异有统计学意义(x2=7.6484,P=0.0218;x2=7.6455,P=0.0219).C组患者治疗144周时HBeAg转阴率为70.0％,血清学转换率为65.0％,高于B组的55.0％和45.0％,以及A组的26.3％和21.0％.治疗24周时HBeAg 下降＞1 lg s/co的33例患者,144周时HBeAg血清学转换高达22例(66.7％),而其他26例患者仅有4例(15.4％)出现HBeAg血清学转换(P＜0.01).实现HBeAg血清学转换的26例患者中已经有20例停药,其中3例HBsAg清除.结论 HBeAg阳性慢性乙型肝炎患者治疗前HBeAg的水平,特别是治疗24周时HBeAg下降＞1 lg s/co者,对于恩替卡韦治疗144周的疗效,特别是HBeAg血清转换率具有重要的预测价值.     

不同策略治疗rtN236T位点变异的HBeAg阳性慢性乙型肝炎的疗效观察

目的 观察rtN236T位点变异的阿德福韦酯(ADV)耐药HBeAg阳性的慢性乙型肝炎(CHB)患者,ADV分别联合聚乙二醇干扰素(Peg-IFN) α-2a及拉米夫定(LAM)进行治疗的疗效及安全性,并分析影响疗效的因素.方法 收集rtN236T位点变异的ADV耐药HBeAg阳性CHB患者65例,随机分为A组(33例)和B组(32例),A组ADV联合Peg-IFN α-2a治疗,连续48周后停用.B组ADV联合LAM治疗,连续48周后,继续使用24周.在治疗前、治疗后24、48周及随访24周,比较两组HBV DNA载量下降≥2log10拷贝/ml和HBV DNA≤500拷贝/ml患者数及HBeAg阴转率、HBeAg血清学转换率、ALT复常率.比较两组行肝穿刺活组织检查患者治疗前后的肝脏炎症分级、纤维化分期及肝组织学活动指数(HAI)评分.根据数据类型用t检验或x2检验进行统计分析.结果 治疗后24、48周及随访24周时,HBV DNA载量下降≥2log10拷贝/ml的患者,A组分别为81.8％、90.9％、75.8％,B组分别为53.1％、56.2％、59.4％;HBV DNA≤500拷贝/ml的患者,A组分别为48.5％、60.6％、42.4％,B组分别为31.3％、34.4％、31.3％;HBeAg阴转率,A组分别为39.4％、60.6％、54.5％,B组分别为12.5％、37.5％、37.5％;HBeAg血清学转换率,A组分别为27.3％、54.5％、48.5％,B组分别为6.3％、15.6％、18.8％;ALT复常率,A组分别为72.7％、84.8％、78.8％,B组分别为46.9％、56.3％、46.9％;A组均明显高于B组,差异有统计学意义(P值均＜0.05).治疗48周后,A组的肝组织HAI积分、炎症分级及纤维化分期改善情况均明显优于B组(P值均＜ 0.05).除肌酐升高发生率差异无统计学意义外,A组的不良反应发生率均高于B组(P值均＜ 0.05),但未发生终止治疗或危及患者安全的不良反应.A组停药随访24周,5例患者HBVDNA升高≥2log10拷贝/ml,其中4例治疗期间HBV DNA≤500拷贝/ml,此4例患者均发生ALT升高,且均未发生HBeAg血清学转换.结论 rtN236T位点变异的ADV耐药HBeAg阳性CHB患者,ADV联合Peg-IFN α-2a的疗效优于联合LAM,但不良反应发生率更高;未发生HBeAg血清学转换的患者,停药后易出现病毒反跳及ALT升高.     

肝脂肪变对聚乙二醇干扰素α-2a治疗慢性乙型肝炎疗效的影响

目的 探讨肝脂肪变对慢性乙型肝炎(CHB)患者应用聚乙二醇干扰素α-2a(PEG-IFNα-2a)抗病毒疗效的影响.方法 对2005年至2009年经肝组织病理学检查确诊的应用PEG-IFNα-2a抗病毒治疗且资料齐全的50例CHB患者进行回顾性分析,依据病理学检测结果将其分为无脂变组(28例)、脂变组(轻度脂肪变21例、中度脂肪变1例).检测血常规、肝肾功能、空腹血糖、血脂,荧光定量PCR法检测HBV DNA载量(下限为500拷贝/rnl),采用电化学发光法检测HBV标志物(HBsAg、抗-HBs、HBeAg、抗-HBe)及甲状腺功能;分析比较两组患者治疗48周时的抗病毒疗效、不良反应情况.对数据中的计量资料采用t检验、计数资料采用x2检验进行统计学分析. 结果 无脂变组HBV DNA阴转率(＜500拷贝/ml)为42.9％,HBeAg/抗-HBe血清学转换率为31.6％,完全应答率39.3％;脂变组HBV DNA阴转率为40.9％,HBeAg/抗-HBe血清学转换率为33.3％,完全应答率40.9％,经x2检验(x2值分别为0.012,0.019,0.014,P值分别为0.600,0.560,0.568),未发现两组患者抗病毒治疗48周时的疗效差异存在统计学意义.两组患者抗病毒治疗后甘油三酯均较治疗前升高(无脂变组t=-2.164,P＜0.05;脂变组t=-2.863,P＜0.05);治疗后两组甘油三酯差异有统计学意义(t=2.412,P＜0.05). 结论 本研究未发现轻度肝脂肪变对CHB患者应用PEG-IFNα-2a抗病毒治疗48周时的疗效有明显影响.     

HBeAg阳性慢性乙型肝炎患者经核苷和核苷酸类药物治疗达标停药后复发的相关因素

目的探讨影响核苷和核苷酸类药物(NAs)治疗HBeAg阳性的慢性乙型肝炎(CHB)患者达到治疗终点停药后复发的相关因素。方法选取2004年5月-2014年12月于广西医科大学第一附属医院就诊并接受NAs治疗的HBeAg阳性CHB患者60例,达到相关指南治疗停药标准后停药。将性别、年龄、HBV感染家族史、基线HBV DNA载量、基线TBil、基线ALT水平、基线AST水平、病毒学应答时间、HBeAg消失时间、开始用药至发生HBeAg血清学转换时间、HBeAg血清学转换后巩固治疗时间、总疗程、延长疗程、停药时HBsAg水平、药物种类共15个可能影响复发的因素进行单因素、多因素Cox比例风险回归模型分析,累积复发率采用Kaplan-Meier法进行分析。结果 60例患者平均疗程(37.36±12.67)个月,延长疗程7.0(2.0~13.0)个月,48个月的复发率为56.7%。性别、年龄、基线HBV DNA载量、基线TBil、基线ALT水平、基线AST水平、病毒学应答时间、巩固治疗时间、总疗程、延长疗程、药物种类对达标停药后复发无明显影响(P值均0.05)。多因素Cox模型分析可以看出,HBV感染家族史[风险比(RR)=1.583,P=0.047)]、HBeAg血清学转换时间(RR=1.205,P=0.015)、停药时HBsAg水平(RR=2.143,P=0.008)是影响停药后复发的独立危险因素。HBeAg血清学转换在12个月以后的复发率高于发生在12个月以内(80.0%vs 48.9%,P0.001)。结论HBV感染家族史、HBeAg血清学转换时间晚、停药时HBsAg高水平是导致NAs治疗达标停药后复发的主要危险因素。HBeAg阳性的CHB患者若能获得免疫控制有利于减少NAs停药后的复发。     

美国2006年慢性乙型肝炎病毒感染处理治疗规范简介

2004年Keeffe等在“临床胃肠病和肝病学”杂志上发表“美国慢性乙型肝炎病毒感染处理治疗规范”。近2年来，由于美国食品药品监督管理局（FDA）先后批准恩替卡韦和聚乙二醇化干扰素（PegIFN）α--2a用于慢性乙型肝炎治疗，并对慢性乙型肝炎的自然史有了新的研究结果，因此，最近Keeffe等美国肝病专家对该《规范》进行了修订，并发表于2006年7月“临床胃肠病和肝病学”杂志。     

Advances in treatment and prevention of hepatitis B

Chronic hepatitis B(CHB) continues to contribute to worldwide morbidity and mortality significantly. Scientists, clinicians, pharmaceutical companies, and health organizations have dedicated substantial Intellectual and monetary resources to finding a cure, increasing immunization rates, and reducing the global burden of CHB. National and international health-related organizations including the center for disease control, the national institute of health, the American Association for the study of liver disease(AASLD), The European association for the study of the Liver(EASL), The Asia Pacific association for the study of the Liver(APASL) and the world health organization release periodic recommendations for disease prevention and treatment. Our review of the most recent guidelines by EASL, AASLD, APASL, and Taiwan Association for the Study of the Liver revealed that an overwhelming majority of cited studies were published before 2018. We reviewed Hepatitis B-related literature published 2018 onwards to identify recent developments and current barriers that will likely direct future efforts towards eradicating hepatitis B. The breakthrough in our understanding of the hepatitis B virus life cycle and resulting drug development is encouraging with significant room for further progress. Data from high-risk populations, most vulnerable to the devastating effects of hepatitis B infection and reactivation remain sparse. Utilization of systems approach, optimization of experimental models, identification and validation of next-generation biomarkers, and precise modulation of the human immune response will be critical for future innovation. Within the foreseeable future, new treatments will likely complement conventional therapies rather than replace them. Most Importantly, pragmatic management of CHB related population health challenges must be prioritized to produce real-world results.     

Maternal knowledge of the risk of vertical transmission and offspring acquisition of hepatitis B

Introduction and objectivesUniversal vaccination at birth and in infancy is key to the elimination of chronic hepatitis B infection. We aimed to assess hepatitis B immune-prophylaxis and perinatal transmission knowledge, in a large and ethnically diverse cohort of previously pregnant North American women, chronically infected with hepatitis B.Materials and methodsThe Hepatitis B Research Network (HBRN) is comprised of 28 Clinical Centers in the United States and Canada. Female cohort participants were administered a questionnaire to assess: (1) their assertion of knowledge regarding HBV prophylaxis at birth, testing, and diagnosis of hepatitis B in their children, and (2) the percentage of affirmative to negative responses for each of the HBV-related interventions her child may have received. The relationship between asserted knowledge, actions taken and maternal demographics were assessed.ResultsA total of 351 mothers with 627 children born in or after 1992 were included. Median age at enrollment was 39.8 years. Mothers were mostly foreign-born with the largest percentage from Asia (73.4%) and Africa (11.7%). Of the 627 children, 94.5% had mothers who asserted that they knew whether their child had received HBIG or HBV vaccine at birth, for 88.8% of the children, their mothers indicated that they knew if their child was tested for HBV and for 84.5% of children, their mothers knew if the child was diagnosed with HBV infection. Among children whose mothers asserted knowledge of their HBV management, 95.3% were reported to have received HBIG or HBV vaccine, 83.4% of children were said to have been tested for HBV, and 4.8% of children were said to have been diagnosed with HBV. Younger maternal age was the only factor significantly associated with higher percentage of children for whom mothers reported knowledge of testing (p = 0.02) or diagnosis of HBV (p = 0.02).ConclusionsWhile high percentages of North American children had mothers asserting knowledge of HBV prophylaxis and testing, knowledge gaps remain, with mothers of 5.5–15.5% of children lacking knowledge of key components of the HBV prevention and diagnosis in the perinatal setting. Targeted education of HBsAg-positive mothers may aid in closing this gap and reducing vertical transmission.     

聚乙二醇干扰素α-2a治疗慢性乙型肝炎获得HBsAg血清转换3例

慢性乙型肝炎最接近治愈的状态是HBsAg清除或血清转换[1].我们对3例应用聚乙二醇干扰素(PEG-IFN α-2a)治疗获得HBsAg血清转换的病例进行总结分析,报道如下.     

HBV RNA作为常规指标指导慢性乙型肝炎治疗决策是否只有几步之遥?

本文根据现有临床证据,讨论了HBsAg和HBV RNA可否作为常规指标指导慢性乙型肝炎的治疗决策。     

Prevalence of hepatitis C virus infection among thalassemia patients: a perspective from a multi-ethnic population of Pakistan

ObjectiveTo evaluate current situation regarding the prevalence of hepatitis C virus (HCV) in thalassemic patients visiting a thalassemia centre in Rawalpindi District, Pakistan for supportive therapy.MethodsSerum samples were screened for hepatitis B surface antigen and anti-HCV by using commercially available ELISA kit. Micro-plate reader was used to perform analysis based on the absorbance/cut-off ratios. Samples were considered positive or negative. Results from ELISA were analyzed statistically.ResultsA total of 95 subjects were observed to have β-thalassemia major (96%) and β-thalassemia intermedia (4%). Among these, 47 (49%) were detected positive for anti-HCV antibodies and three for hepatitis B surface antigen. All recruited subjects were observed for therapy/medication behavior and clinical complications. About 83 (87%) patients were on chelation therapy, and overall complications (hepatomegaly, splenomegaly and splenectomy) were observed in 81% individuals. The distribution of disease status (thalassemia and hepatitis) was not significantly associated with gender, age, origin, province, socio-economic status and parental marriage type (P>0.05). The distributions of ferritin levels, therapy/medication and complications were assessed across demographic variables. Thalassemic subjects were distributed with respect to their sporadic and familial presentations. Among the familial cases (n=35), a total of 93 subjects were found to be affected. Parity was scored for the index cases, and majority belonged to second parity (29%), followed by first and third parities (25% and 15%, respectively). The sibship size was increasing with increasing parity level.ConclusionsAlthough standardized blood screening procedures are supposed to be implemented, higher prevalence of HCV in thalassemic patients requires greater attention in Pakistan. Furthermore, a poor compliance regarding iron chelation therapy has been observed in this study.     

Incidence of HBV variants with a mutation at nt551 among hepatitis B patients in Nanjing and its neighbourhood

AIM: To investigate the epidemiology of hepatitis B virus (HBV) strains with a mutation at nt551 in surface gene among hepatitis B patients in Nanjing and its neighbourhood. METHODS: By using mutation-specific polymerase chain reaction (msPCR) established by our laboratory for amplifying HBV DNAs with a mutation at nt551, 117 serum samples taken from hepatitis B patients were detected. RESULTS: The results showed that 112 samples were positive for nt551A, 4 samples were positive for nt551G. One sample was positive for nt551T. No nt551C of HBV DNA was found. The incidence of HBsAg mutants with G, C, T, A at nt551 among 117 samples was 3.42%, 0%, 0.85%, 95.73%, respectively. CONCLUSION: In Nanjing and its neighbourhood, hepatitis B patients are mainly infected with wild genotype HBV. The incidence of mutants with a mutation at nt551 in HBV genome is significantly lower than that in wild genotype HBV DNA (P<0.01). The necessity of adding components of HBsAg mutants to HBV vaccine needs further investigation.     

拉米夫定治疗其他方法抗病毒治疗失败的慢性乙型肝炎患者的疗效

目的观察拉米夫定对复发性慢性乙型肝炎患者的疗效和安全性。方法选择27例其他方法抗病毒治疗失败的慢性乙型肝炎患者,给予拉米夫定100mg口服,每日一次,连续服用12个月。结果治疗后12个月时ALT和血清总胆红素平均值(分别为52.7±26.5U/L和19.7±21.1μmol/L),与治疗前平均值(211.3±182.4U/L和54.6±28.8μmol/L)相比显著下降(P<0.01);其ALT复常率为88.9%(24/27),HBV DNA阴转率77.8%(21/27),HBeAg阴转率29.6%(8/27),HBeAg/抗-HBe血清转换率18.5%(5/27)。停药后6个月内有7例复发。治疗全程未见严重不良反应。结论拉米夫定治疗其他方法抗病毒治疗失败的慢性乙型肝炎患者也能够迅速抑制病毒的复制,使肝功能复常,而且安全、方便。