| 摘要: |
| [摘要]目的：探讨干扰素α-1b序贯拉米夫定联合治疗小儿慢性乙型肝炎的疗效及其对肝功能、病毒学的影响。方法：选取2015年11月至2017年5月我院收治的慢性乙型肝炎患儿136例，根据随机数表分为研究组和对照组各68例。对照组仅给予干扰素α-1b，肌肉注射，隔日1次，每次30 μg/m2，连续治疗1个月后，改为每次60 μg/m2，隔日肌肉注射1次，连续治疗6个月。研究组采用干扰素α-1b与拉米夫定序贯治疗，首先口服拉米夫定，每日按3 mg/kg顿服，连续治疗1个月，后肌肉注射干扰素α-1b。观察两组患儿治疗前及治疗后1、3、6个月肝功能、病毒学水平，并进行疗效评价。结果：两组治疗后1、3、6个月丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）和总胆红素（TBIL）水平均低于治疗前，且呈降低趋势，差异均有统计学意义（P<0.05）；研究组治疗后1、3、6个月ALT、AST和TBIL水平均低于对照组，差异有统计学意义（P<0.05）。两组治疗后1、3、6个月乙型肝炎病毒e抗原（HBeAg）水平均低于治疗前（P<0.05）；对照组治疗后6个月HBV-DNA水平低于治疗前及治疗后1个月，差异有统计学意义（P<0.05）；研究组治疗后1、3、6个月HBV-DNA水平均低于治疗前，且治疗后3、6个月低于治疗后1个月，差异均有统计学意义（P<0.05）；研究组治疗后3、6个月HBeAg、HBV-DNA水平均低于对照组，差异有统计学意义（P<0.05）；研究组治疗后6个月HBeAg转阴率高于对照组（P<0.05）；对照组治疗后6个月HBeAg转阴率高于治疗后1、3个月，治疗后3、6个月HBeAg转换率高于治疗后1个月，差异均有统计学意义（P<0.05）；研究组治疗后3、6个月HBV-DNA应答率高于治疗后1个月（P<0.05），治疗后6个月HBeAg转阴率高于治疗后1、3个月，治疗后3、6个月HBeAg转换率高于治疗后1个月，差异均有统计学意义（P<0.05）。结论：干扰素α-1b与拉米夫定序贯治疗小儿慢性乙型肝炎可显著改善患儿肝功能，抑制乙肝病毒活性，提高HBeAg转阴率，临床效果优于单用干扰素α-1b。 |
| 关键词: 乙型 肝炎 儿童 干扰素 拉米夫定 |
| DOI：doi:10.13407/j.cnki.jpp.1672-108X.2020.05.004 |
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| 基金项目:2018 年河北省医学科学研究重点课题计划项目,编号 20181073。 |
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| Interferon α-1b Combined with Lamivudine in the Sequential Treatment of Children with Chronic Hepatitis B |
| Li Bo, Zheng Huanwei |
| (The Fifth Hospital of Shijiazhuang, Hebei Shijiazhuang 050024, China) |
| Abstract: |
| [Abstract] Objective: To probe into the efficacy of interferon α-1b combined with lamivudine in the sequential treatment of children with chronic hepatitis B and its effects on liver function and virology. Methods: A total of 136 children with chronic hepatitis B admitted into our hospital from Nov. 2015 to May 2017 were extracted to be divided into the study group and the control group via the random number table, with 68 cases in each group. The control group was treated with interferon α-1b in intramuscular injection, once every other day, 30 μg/m2 each time, after 1 month of continuous treatment, the patients were given 60 μg/m2 each time in intramuscular injection, once every other day, for 6 months. The study group was given interferon α-1b combined with lamivudine, lamivudine was taken orally, 3 mg/kg daily for 1 month, followed by intramuscular injection of interferon α-1b with the same dose of the control group. Liver function and virology of two groups were observed before treatment and after treatment of 1, 3 and 6 months. Efficacy was evaluated after treatment. Results: The levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin (TBIL) of two groups were lower than those before treatment and after treatment of 1, 3 and 6 months, with a decreasing trend, and the differences were statistically significant (P<0.05). The levels of ALT, AST and TBIL in the study group were lower than those in the control group after treatment of 1, 3, and 6 months, and the difference was statistically significant (P<0.05). After treatment of 1, 3 and 6 months, the levels of hepatitis B E antigen (HBeAg) in both groups were lower than those before treatment (P<0.05); the levels of HBV-DNA in the control group after treatment of 6 months was lower than those before treatment and after treatment of 1 month, the difference was statistically significant (P<0.05). The levels of HBV-DNA in the study group after treatment of 1, 3 and 6 months were lower than those before treatment, and the data after treatment of 3 and 6 months were lower than those after treatment of 1 month, with statistically significant difference (P<0.05). The levels of HBeAg and HBV-DNA in the study group were lower than those in the control group after treatment of 3 and 6 months, the difference was statistically significant (P<0.05). The negative conversion rate of HBeAg in the study group was higher than that in the control group after treatment of 6 months (P<0.05). The negative conversion rate of HBeAg in the control group after treatment of 6 months was higher than that after treatment of 1 and 3 months, the negative conversion rate of HBeAg after treatment of 3 and 6 months was higher than that after treatment of 1 month, the difference was statistically significant (P<0.05). The response rate of HBV-DNA in the study group after treatment of 3 and 6 months was higher than that after treatment of 1 month, the negative conversion rate of HBeAg after treatment of 3 and 6 months was higher than that after treatment of 1 month, the difference was statistically significant (P<0.05). Conclusion: Interferon α-1b combined with lamivudine in the sequential treatment of children with chronic hepatitis B can significantly improve the liver function of children, inhibit hepatitis B virology, and increase the negative conversion rate of HBeAg. The clinical efficacy of interferon α-1b combined with lamivudine in the sequential treatment is better than interferon α-1b alone. |
| Key words: hepatitis B hepatitis children interferon lamivudine |
