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目的探讨阿德福韦酯治疗HBeAg(+)慢性乙型肝炎的疗效预测指标,为个体化治疗提供依据。方法于2004年10月至2005年12月在北京大学第一医院等5所医院进行该研究,选取连续应用阿德福韦酯治疗48周的HBeAg(+)慢性乙型肝炎患者共140例,采用Logistic回归分析阿德福韦酯治疗48周的疗效预测指标。结果基线血清丙氨酸转氨酶(ALT)、HBV DNA水平和24周时HBV DNA阴转为48周HBV DNA阴转的预测指标;研究中基线ALT≥134.5U/L、HBV DNA≤6.57lg拷贝/mL和24周HBV DNA阴转者治疗至48周时的HBV DNA阴转率(93.3%)、HBeAg阴转率(60%)、HBeAg血清转换率(40%)均较高。治疗24周时HBV DNA未阴转者继续治疗至48周时仍有47.8%的患者发生HBV DNA阴转、8.6%的患者发生HBeAg血清转换。结论慢性乙型肝炎患者应用阿德福韦酯治疗前HBV DNA低水平、ALT高水平且24周时HBV DNA阴转是48周疗效较好的预测指标;治疗24周时HBV DNA未阴转者不应放弃治疗。
Objective To investigate the predictive value of adefovir dipivoxil in the treatment of chronic hepatitis B with HBeAg (+) and provide the basis for individualized treatment. Methods From October 2004 to December 2005 in Peking University First Hospital and other five hospitals for the study, selected continuous application of adefovir dipivoxil in 48 weeks of HBeAg (+) chronic hepatitis B patients a total of 140 cases, Logistic regression analysis of adefovir dipivoxil treatment for 48 weeks prognostic indicators. Results Baseline serum alanine aminotransferase (ALT), HBV DNA level and HBV DNA negative conversion at 24 weeks were the predictors of HBV DNA negative conversion at 48 weeks. Baseline ALT ≥134.5U / L, HBV DNA ≤6.57lg copies / HBV DNA negative conversion rate (93.3%), HBeAg negative conversion rate (60%), and HBeAg seroconversion rate (40% HBV DNA underexposure was continued at week 24 after treatment in 47.8% of patients with HBV DNA negative conversion at week 48, and HBeAg seroconversion in 8.6% of patients. Conclusion Adefovir dipivoxil treatment in patients with chronic hepatitis B before treatment of low levels of HBV DNA, ALT high levels and 24 weeks HBV DNA negative conversion is a good predictor of 48 weeks prognosis; 24 weeks after treatment of HBV DNA is not negative Should not give up treatment.