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目的探讨拉米夫定对慢性乙肝患者外周血单个核细胞(PBMC)及血清内HBV-DNA的阴转效果和对细胞因子的影响。方法将81例慢性乙肝患者分为A(47例)、B(34例)两组,分别采用拉米夫定和常规治疗,于治疗前后分别检测患者PBMC、血清中HBV-DNA和细胞因子水平。结果拉米夫定治疗36周后,慢性乙肝患者PBMC内和血清中HBV-DNA阴转率分别为55.32%(26/47)和61.70%(29/47),常规治疗组PBMC内和血清中HBV-DNA阴转率分别为26.47%(9/34)和32.35%(11/34),两者相比差异有统计学意义(P<0.01)。拉米夫定治疗24、36周后,慢性乙肝患者血清HBeAg的阴转率分别为46.81%(22/47)和68.09%(32/47),与常规治疗组相比,差异有统计学意义(P<0.05和P<0.01)。采用拉米夫定和常规治疗后,丙氨酸转氨酶(ALT)、门冬氨酸转氨酸(AST)、ALT/AST水平分别为(30.1±9.6)U/ml、(32.3±10.7)U/ml、0.9±0.1和(48.4±10.7)U/ml、(44.7±11.0)U/ml、1.1±0.2,差异有统计学意义(P<0.01)。慢性乙肝患者IL-6、IL-8、TNF-α表达水平较高,拉米夫定可显著下调IL-6、IL-8、TNF-α至(250.5±33.3)pg/ml、(153.4±22.2)pg/ml、(232.6±21.2)pg/ml,与常规治疗组相比差异有统计学意义(P<0.01)。结论拉米夫定对PBMC及血清内HBV-DNA均具有较好的治疗效果,其阴转率明显高于常规治疗法。拉米夫定比常规药物更具有减轻局部炎性细胞因子浸润、分泌和促进肝细胞功能恢复的作用。
Objective To investigate the effect of lamivudine on the negative conversion of peripheral blood mononuclear cells (PBMCs) and HBV-DNA in serum and cytokines in chronic hepatitis B patients. Methods Eighty-one chronic hepatitis B patients were divided into two groups: A (n = 47) and B (n = 34). The patients were treated with lamivudine and routine therapy respectively. PBMC and serum HBV- . Results After 36 weeks of lamivudine treatment, HBV-DNA negative rates in PBMC and serum of patients with chronic hepatitis B were 55.32% (26/47) and 61.70% (29/47), respectively The negative conversion rate of HBV-DNA was 26.47% (9/34) and 32.35% (11/34), respectively. The difference was statistically significant (P <0.01). After 24 and 36 weeks of lamivudine treatment, the serum HBeAg negative rates in patients with chronic hepatitis B were 46.81% (22/47) and 68.09% (32/47), respectively, which were significantly different from those in the conventional treatment group (P <0.05 and P <0.01). The levels of ALT, AST and ALT / AST were (30.1 ± 9.6) U / ml and (32.3 ± 10.7) U respectively after lamivudine and routine treatment / ml, 0.9 ± 0.1 and (48.4 ± 10.7) U / ml, (44.7 ± 11.0) U / ml and 1.1 ± 0.2, respectively, with statistical significance (P <0.01). The levels of IL-6, IL-8 and TNF-α in patients with chronic hepatitis B were higher than those in patients with chronic hepatitis B, and lamivudine significantly decreased the levels of IL-6, IL-8 and TNF-α to 250.5 ± 33.3 pg / 22.2) pg / ml and (232.6 ± 21.2) pg / ml, respectively. The difference was statistically significant compared with the conventional treatment group (P <0.01). Conclusion Lamivudine has good therapeutic effect on HBV-DNA in PBMC and serum, and the negative conversion rate of lamivudine is obviously higher than that of conventional therapy. Lamivudine more than conventional drugs to reduce the local inflammatory cytokines infiltration, secretion and promote the recovery of liver cell function.