患者男,45岁,因厌食、尿黄1周入院.否认家族性肝病史及既往肝炎病史.体格检查:皮肤、巩膜轻度黄染,心肺未闻及异常,腹软,肝脾肋下未触及,肝区叩击痛,腹部移动性浊音阴性,双下肢无水肿.

目的:探讨聚乙二醇化干扰素α-2a(PEG-IFN α-2a,派罗欣)联合利巴韦林(RBV)治疗慢性丙型肝炎疗效。方法:30例慢性丙型肝炎患者根据体重不同每周皮下注射1次PEG-IFN α-2a 180μg或135μg,同时联合利巴韦林800~1000 mg/d,分别于治疗前及治疗后4、12、24、48周时检测ALT(谷丙转氨酶)及HCV RNA(丙型肝炎病毒核糖核酸)定量。结果:30例患者根据基因分型均按预计完成疗程(28例治疗48周,2例治疗24周),HCV RNA阴转率在治疗4周时达90%,在12、24和48周时均达100%。ALT复常率在治疗结束时,24周达95%,48周达94.4%。结论:PEG-IFN α-2a联合利巴韦林在慢性丙型肝炎治疗中显示了良好的病毒学及生化学应答反应,且提高了患者治疗依从性,能取得比较好的治疗效果。

Objective: To retrospect clinical efficacy of entecavir in the treatment of chronical hepatitis B.Methods: 56 patients with chronical hepatitis B were recruited as subjects.Half of the subjects were assigned into the investigational group in which entecavir was taken in a dose of 0.5 mg per day and the left given 100 mg of lamivudine daily into control group.Normalization of ALT,negative rate of HBV DNA in the serum and the seroconversion of e-antigen in the two groups were detected at 4,8,12 and 24 wk respectively.Results: Normalization rate of ALT,negative rate of HBV DNA and serum conversion rate of e-antigen in the treatment group and the control group were 25% and 21%(P> 0.05),50% and 25%(P> 0.05),0% and 5%(P>0.05) respectively at 4 wk;36% and 29%(P> 0.05),71% and 32%(P<0.05),19% and 21%(P> 0.05) at 8 wk;54% and 39%(P> 0.05),75% and 71%(P> 0.05),31% and 32%(P> 0.05) at 12 wk;75% and 61%(P>0.05),89% and 75%(P>0.05),44% and 42%(P>0.05) at 24 wk.Conclusion: Entecavir can suppress the replication of hepatitis B virus more effectively in an earlier stage,compared with lamivudine.There is no significant difference in normalization of ALT and serum conversion rate of e-antigen between the two groups along with the decline in the level of HBV DNA.

目的探讨替比夫定抗乙型肝炎病毒的疗效。方法对服用替比夫定抗病毒治疗的74例慢性乙型肝炎及肝硬化患者分别于治疗前及治疗后4、8、12、24周进行病毒学、血清学及生化学检测。结果治疗12周时HBV-DNA检测不到为79.73%,治疗24周时病毒学应答率82.43%,其中生化学应答率93.44%;HBeAg阳性组中24周时HBV-DNA检测不到为65.52%,HBeAg/HBeAb转换率34.42%;HBeAg阴性组中HBV-DNA检测不到达到100%。结论替比夫定抗乙肝病毒治疗病毒学应答出现早,血清学应答率高。