【摘要】：[目的]針對ALT水平正常的慢性HBV感染者抗病毒治療難點,通過早期應(yīng)用核苷(核苷酸)類藥物抗病毒治療,對有應(yīng)答的患者,給予持續(xù)抗病毒治療,經(jīng)長期隨訪,探討該類型HBV感染者接受抗病毒的可行性、必要性。[方法]將患者根據(jù)實驗納入標(biāo)準(zhǔn)和排除標(biāo)準(zhǔn)分為HBeAg陽性患者ALT正常組和ALT≥2×ULN組,HBeAg陰性患者ALT正常組和ALT≥2×ULN組共四組隊列。對ALT正常的HBeAg陽性和HBeAg陰性患者抗病毒,若持續(xù)抗病毒治療后12周HBV DNA較基線下降幅度1log10IU/ml或24周HBV DNA較基線下降幅度21og10IU/ml,考慮免疫耐受,停止抗病毒治療。觀察ALT正常HBeAg陽性和HBeAg陰性患者在連續(xù)抗病毒治療48周及延長治療時間后HBV DNA低于檢測下限比例、HBeAg血清學(xué)轉(zhuǎn)換比例,ALT復(fù)常比例,并和ALT≥2×ULN組對比評價他們的抗病毒療效及差異。[結(jié)果]1、HBeAg陽性患者ALT正常組48wHBVDNA低于檢測下限的比例、HBeAg血清學(xué)轉(zhuǎn)換比例和ALT≥2×ULN組相比兩組間無統(tǒng)計學(xué)差異。2、HBeAg陰性患者ALT正常組和ALT≥2×ULN組48wHBVDNA低于檢測下限的比例均為100%,兩組間無統(tǒng)計學(xué)差異。3、ALT正常HBeAg陽性患者和陰性患者48wHBV DNA低于檢測下限比例無統(tǒng)計學(xué)差異。4、ALT≥2×ULN組HBeAg陽性患者48wHBVDNA低于檢測下限比例、ALT復(fù)常比例和陰性患者組比較無統(tǒng)計學(xué)差異。5、ALT正常HBeAg陰性患者經(jīng)過抗病毒治療,肝彈性值有所下降,并有恢復(fù)正常的趨勢,ALT正常HBeAg陽性患者肝彈性值抗病毒治療前后無統(tǒng)計學(xué)差異。6、淋巴細(xì)胞分類及計數(shù)中CD3+,CD3+CD8+,CD19+絕對值均值治療后較治療前升高,P值分別為0.038,0.024,0.008,有統(tǒng)計學(xué)意義。[結(jié)論]1.ALT正常的HBeAg陽性的慢性HBV感染者,除原發(fā)性無應(yīng)答外,經(jīng)抗病毒治療,HBVDNA水平可顯著降低,并有一定比例的患者實現(xiàn)HBeAg血清學(xué)轉(zhuǎn)換。與ALT2×ULN組慢乙肝患者抗病毒療效無差異,建議對早期有病毒學(xué)應(yīng)答的ALT正常的HBeAg陽性感染者應(yīng)該予以抗病毒治療。2.ALT正常的HBeAg陰性的慢性HBV感染者,經(jīng)抗病毒治療,HBV DNA水平均達(dá)到檢測下限以下,與ALT2×ULN組HBeAg陰性慢乙肝患者抗病毒療效無差異,建議對ALT正常的HBeAg陰性的慢性HBV感染者應(yīng)予抗病毒治療。3.ALT正常HBeAg陰性患者經(jīng)過抗病毒治療,肝彈性值有所下降,并有恢復(fù)正常的趨勢,ALT正常HBeAg陽性患者肝彈性值抗病毒治療前后無統(tǒng)計學(xué)差異,提示抗病毒治療有阻止或延緩肝臟疾病的發(fā)展,患者從抗病毒治療中獲益。4.患者使用肝龍后,CD3+,CD3+CD8+,CD19+絕對值均值治療后較治療前升高,有統(tǒng)計學(xué)意義,提示T淋巴細(xì)胞和B淋巴細(xì)胞數(shù)量增多,可以提高免疫狀態(tài),有利于乙肝病毒的清除。
[Abstract]:[objective] to deal with the difficulties of antiviral therapy in chronic HBV infected patients with normal ALT level, early antiviral therapy with nucleotides (nucleotides) was used, and continuous antiviral therapy was given to the responding patients, and the patients were followed up for a long time. To explore the feasibility and necessity of receiving anti-virus in this type of HBV infection. [methods] the patients were divided into four groups according to the inclusion criteria and exclusion criteria: ALT normal group, ALT 鈮，

本文編號：2181108