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目的探讨抗HBV-DC联合药物治疗乙型肝炎病毒携带者的临床疗效。方法 HBe Ag阳性慢性HBV携带者13例和HBe Ag阴性慢性HBV携带者2例进行研究。取50 ml肝素抗凝外周静脉血,用贴壁法与密度梯度离心得出PBMC,IL-4和GM-CSF诱导DC增加,分别于0、4、12周检测肝功能、HBV-DNA定量、HBVM定量。结果治疗后4、12周的Hbe Ag、HBV-DNA、Hbs Ag明显降低。1例治疗前为HBs Ag和HBe Ag阳性,治疗后HBV-DNA明明显下降,HBc Ab转阳性。1例4周时HBs Ab转阳性,未出现HBs Ag/HBs Ab的血清转换。1例4周时出现HBe Ag/HBe Ab血清转换,转换率7.7%(1/13),另1例12周时出现HBe Ag/HBe Ab血清转换,总转换率15.4%(2/13)。4例4周时HBV-DNA转阴,转阴率30.8%(4/15),另4例12周时HBV-DNA转阴,总HBV-DNA转阴率61.5%(8/15)。治疗前ALT均正常,治疗后3例4周时ALT升高1~2倍,其中2例12周时恢复正常,另1例12周时ALT轻度升高。结论抗HBV-DC联合替比夫定治疗,可有效地抑制慢性HBV携带者的HBV-DNA复制,对血中Hbe Ag、HBV-DNA、HBs Ag快速降低,提高HBe Ag/HBe Ab的血清学转换率,是治疗慢性HBV携带者有效安全的方法。
Objective To investigate the clinical efficacy of anti-HBV-DC combined treatment of hepatitis B virus carriers. Methods Thirteen HBeAg-positive chronic HBV carriers and two HBeAg-negative chronic HBV carriers were studied. Take 50 ml of heparin anticoagulated peripheral blood, PBMC was induced by adherent method and density gradient centrifugation, IL-4 and GM-CSF induced DC increased, respectively, at 0,4,12 weeks to detect liver function, HBV-DNA quantification, HBVM quantitative. Results Hbe Ag, HBV-DNA and Hbs Ag were significantly decreased at 4 and 12 weeks after treatment. One patient was positive for HBs Ag and HBe Ag before treatment, HBV-DNA was obviously decreased after treatment, and HBc Ab turned positive. One case of HBs Ab was positive at 4 weeks, and seroconversion of HBs Ag / HBs Ab did not occur. HBe Ag / HBe Ab seroconversion occurred in 1 case at 4 weeks, with a conversion rate of 7.7% (1/13). In the other 1 case, HBe Ag / HBe Ab seroconversion occurred at 12 weeks with a total conversion rate of 15.4% (2/13). The HBV-DNA was negative and the rate of negative conversion was 30.8% (4/15) in 4 cases at 4 weeks. The other 4 cases turned negative at 12 weeks and the total HBV-DNA negative rate was 61.5% (8/15). ALT was normal before treatment, ALT increased 1 ~ 2 times 4 weeks after treatment in 3 cases, of which 2 cases returned to normal after 12 weeks, another case of ALT increased slightly at 12 weeks. Conclusions Anti-HBV-DC combined with telbivudine can effectively inhibit HBV-DNA replication in chronic HBV carriers and rapidly decrease HbeAg, HBV-DNA and HBsAg in serum and increase the serological activity of HBe Ag / HBe Ab Conversion rate, is the treatment of chronic HBV carriers effectively and safely.