拉米夫定对慢性乙型肝炎患者血清透明质酸水平的影响
韩群英, 刘正稳, 张妮, 朱凤群, 西安交通大学第一医院传染科 陕西省西安市 710061
陕西省科技攻关项目, No. 2000K14-G16
通讯作者: 刘正稳,710061, 陕西省西安市, 西安交通大学医学院第一附属医院传染科. zhengwenl@sohu.com
电话: 029-85324066 传真: 029-85226360
收稿日期: 2005-03-01 接受日期: 2005-03-22
摘要
目的:探讨拉米夫定治疗慢性乙型肝炎对血清透明质酸水平的影响及其变化的临床意义.
, http://www.100md.com
方法:6 mo内未用过任何抗病毒治疗的慢性乙型肝炎患者47例，用拉米夫定治疗12 mo，分别于治疗前、治疗的3 mo、6 mo和12 mo测定肝功能、乙型肝炎病毒(HBV)血清标记物、HBV DNA和血清透明质酸水平.
结果:拉米夫定可降低慢性乙型肝炎患者的血清透明质酸水平.在拉米夫定治疗过程中，血清透明质酸水平随着肝功的好转同步下降.在12 mo末，HBV DNA水平阴转组与未阴转组治疗前的血清透明质酸水平无显著性差异，但阴转组的血清透明质酸水平较未阴转组下降较早.HBeAg阴转组治疗前的血清透明质酸水平明显高于HBeAg未阴转组(t= 2.380，P= 0.022)，HBeAb阳转组(t= 2.767，P= 0.008)治疗前的血清透明质酸水平也明显高于HBeAb未阳转组.HBeAg阴转和HBeAb阳转的患者，在治疗过程中血清透明质酸水平下降较早，即在治疗的第3 mo即有明显下降.治疗期末HBeAg阴转与否(P = 0.022)和HBeAb阳转与否(P= 0.045)均与血清透明质酸水平有关.
, http://www.100md.com
结论:治疗前的血清透明质酸水平和治疗过程中的血清透明质酸水平下降的早晚与拉米夫定的疗效有关，血清透明质酸水平对拉米夫定治疗慢性乙型肝炎的应答有预测意义.
韩群英, 刘正稳, 张妮, 朱凤群. 拉米夫定对慢性乙型肝炎患者血清透明质酸水平的影响. 世界华人消化杂志 2005;13(8):1045-10471 Guechot J, Serfaty L, Bonnand AM, Chazouilleres O, Poupon RE, Poupon R. Prognostic value of serum hyaluronan
in patients with compensated HCV cirrhosis. J Hepatol 2000;32:447-452
2 Kojima H, Hongo Y, Harada H, Inoue T, Miyaji K, Kashiwagi M, Momose T, Arisaka Y, Fukui H, Murai S, Tokita H,Kamitsukasa H, Yagura M, Katsu K. Long-term histological prognosis and serum fibrosis markers in chronic hepatitis C
, http://www.100md.com
patients treated with interferon. J Gastroenterol Hepatol 2001;16:1015-1021
3 中华医学会传染病与寄生虫病学分会、肝病学分会. 病毒性肝炎防治方案. 中华肝脏病杂志 2000;8:324-329
4 Suzuki Y, Kumada H, Ikeda K, Chayama K, Arase Y, Saitoh S, Tsubota A, Kobayashi M, Koike M, Ogawa N,Tanikawa K. Histological changes in liver biopsies after one year of lamivudine treatment in patients with chronic
hepatitis B infection. J Hepatol 1999;30:743-748
, http://www.100md.com
5 Liaw YF, Sung JJ, Chow WC, Farrell G, Lee CZ, Yuen H, Tanwandee T, Tao QM, Shue K, Keene ON, Dixon JS, Gray DF,Sabbat J;Cirrhosis Asian Lamivudine Multicentre Study Group. Lamivudine for patients with chronic hepatitis B and
advanced liver disease. N Engl J Med 2004;351:1521-1531
6 Kweon YO, Goodman ZD, Dienstag JL, Schiff ER, Brown NA, Burchardt E, Schoonhoven R, Brenner DA, Fried MW.
, 百拇医药 Decreasing fibrogenesis:an immunohistochemical study of paired liver biopsies following lamivudine therapy for chronic
hepatitis B. J Hepatol 2001;35:749-755
7 Patel K, Lajoie A, Heaton S, Pianko S, Behling CA, Bylund D, Pockros PJ, Blatt LM, Conrad A, McHutchison JG. Clinical use
of hyaluronic acid as a predictor of fibrosis change in hepatitis C. J Gastroenterol Hepatol 2003;18:253-257
, 百拇医药
8 Guechot J, Loria A, Serfaty L, Giral P, Giboudeau J, Poupon R. Serum hyaluronan as a marker of liver fibrosis in
chronic viral hepatitis C: effect of alpha-interferon therapy. J Hepatol 1995;22:22-26
9 Hashimoto O, Ueno T, Sata M, Uchimura Y, Tanikawa K. Long-term improvement of hepatic fibrosis in chronic hepatitis
C treated with interferon-a. Hepatol Res 1998;10:200-216
, 百拇医药
10 Chen YP, Feng XR, Dai L, Zhang L, Hou JL. Non-invasive diagnostic screening of hepatic fibrosis in patients with
chronic hepatitis B. Chin Med J (Engl) 2004;117:1109-1112
11 Zheng M, Cai W, Weng H, Liu R. Determination of serum fibrosis indexes in patients with chronic hepatitis and
its significance. Chin Med J (Engl) 2003;116:346-349
12 Pares A, Deulofeu R, Gimenez A, Caballeria L, Bruguera M, Caballeria J, Ballesta AM, Rodes J. Serum hyaluronate
, http://www.100md.com
reflects hepatic fibrogenesis in alcoholic liver disease and is useful as a marker of fibrosis. Hepatology
1996;24:1399-1403
13 Lai CL, Ratziu V, Yuen MF, Poynard T. Viral hepatitis B. Lancet 2003;362:2089-2094
14 Niederau C, Heintges T, Lange S, Goldmann G, Niederau CM, Mohr L, Haussinger D. Long-term follow-up of
HBeAg-positive patients treated with interferon alfa for chronic hepatitis B. N Engl J Med 1996;334:1422-1427
编辑 张海宁, 百拇医药( 韩群英,刘正稳, 张 妮, 朱凤群)
陕西省科技攻关项目, No. 2000K14-G16
通讯作者: 刘正稳,710061, 陕西省西安市, 西安交通大学医学院第一附属医院传染科. zhengwenl@sohu.com
电话: 029-85324066 传真: 029-85226360
收稿日期: 2005-03-01 接受日期: 2005-03-22
摘要
目的:探讨拉米夫定治疗慢性乙型肝炎对血清透明质酸水平的影响及其变化的临床意义.
, http://www.100md.com
方法:6 mo内未用过任何抗病毒治疗的慢性乙型肝炎患者47例，用拉米夫定治疗12 mo，分别于治疗前、治疗的3 mo、6 mo和12 mo测定肝功能、乙型肝炎病毒(HBV)血清标记物、HBV DNA和血清透明质酸水平.
结果:拉米夫定可降低慢性乙型肝炎患者的血清透明质酸水平.在拉米夫定治疗过程中，血清透明质酸水平随着肝功的好转同步下降.在12 mo末，HBV DNA水平阴转组与未阴转组治疗前的血清透明质酸水平无显著性差异，但阴转组的血清透明质酸水平较未阴转组下降较早.HBeAg阴转组治疗前的血清透明质酸水平明显高于HBeAg未阴转组(t= 2.380，P= 0.022)，HBeAb阳转组(t= 2.767，P= 0.008)治疗前的血清透明质酸水平也明显高于HBeAb未阳转组.HBeAg阴转和HBeAb阳转的患者，在治疗过程中血清透明质酸水平下降较早，即在治疗的第3 mo即有明显下降.治疗期末HBeAg阴转与否(P = 0.022)和HBeAb阳转与否(P= 0.045)均与血清透明质酸水平有关.
, http://www.100md.com
结论:治疗前的血清透明质酸水平和治疗过程中的血清透明质酸水平下降的早晚与拉米夫定的疗效有关，血清透明质酸水平对拉米夫定治疗慢性乙型肝炎的应答有预测意义.
韩群英, 刘正稳, 张妮, 朱凤群. 拉米夫定对慢性乙型肝炎患者血清透明质酸水平的影响. 世界华人消化杂志 2005;13(8):1045-10471 Guechot J, Serfaty L, Bonnand AM, Chazouilleres O, Poupon RE, Poupon R. Prognostic value of serum hyaluronan
in patients with compensated HCV cirrhosis. J Hepatol 2000;32:447-452
2 Kojima H, Hongo Y, Harada H, Inoue T, Miyaji K, Kashiwagi M, Momose T, Arisaka Y, Fukui H, Murai S, Tokita H,Kamitsukasa H, Yagura M, Katsu K. Long-term histological prognosis and serum fibrosis markers in chronic hepatitis C
, http://www.100md.com
patients treated with interferon. J Gastroenterol Hepatol 2001;16:1015-1021
3 中华医学会传染病与寄生虫病学分会、肝病学分会. 病毒性肝炎防治方案. 中华肝脏病杂志 2000;8:324-329
4 Suzuki Y, Kumada H, Ikeda K, Chayama K, Arase Y, Saitoh S, Tsubota A, Kobayashi M, Koike M, Ogawa N,Tanikawa K. Histological changes in liver biopsies after one year of lamivudine treatment in patients with chronic
hepatitis B infection. J Hepatol 1999;30:743-748
, http://www.100md.com
5 Liaw YF, Sung JJ, Chow WC, Farrell G, Lee CZ, Yuen H, Tanwandee T, Tao QM, Shue K, Keene ON, Dixon JS, Gray DF,Sabbat J;Cirrhosis Asian Lamivudine Multicentre Study Group. Lamivudine for patients with chronic hepatitis B and
advanced liver disease. N Engl J Med 2004;351:1521-1531
6 Kweon YO, Goodman ZD, Dienstag JL, Schiff ER, Brown NA, Burchardt E, Schoonhoven R, Brenner DA, Fried MW.
, 百拇医药 Decreasing fibrogenesis:an immunohistochemical study of paired liver biopsies following lamivudine therapy for chronic
hepatitis B. J Hepatol 2001;35:749-755
7 Patel K, Lajoie A, Heaton S, Pianko S, Behling CA, Bylund D, Pockros PJ, Blatt LM, Conrad A, McHutchison JG. Clinical use
of hyaluronic acid as a predictor of fibrosis change in hepatitis C. J Gastroenterol Hepatol 2003;18:253-257
, 百拇医药
8 Guechot J, Loria A, Serfaty L, Giral P, Giboudeau J, Poupon R. Serum hyaluronan as a marker of liver fibrosis in
chronic viral hepatitis C: effect of alpha-interferon therapy. J Hepatol 1995;22:22-26
9 Hashimoto O, Ueno T, Sata M, Uchimura Y, Tanikawa K. Long-term improvement of hepatic fibrosis in chronic hepatitis
C treated with interferon-a. Hepatol Res 1998;10:200-216
, 百拇医药
10 Chen YP, Feng XR, Dai L, Zhang L, Hou JL. Non-invasive diagnostic screening of hepatic fibrosis in patients with
chronic hepatitis B. Chin Med J (Engl) 2004;117:1109-1112
11 Zheng M, Cai W, Weng H, Liu R. Determination of serum fibrosis indexes in patients with chronic hepatitis and
its significance. Chin Med J (Engl) 2003;116:346-349
12 Pares A, Deulofeu R, Gimenez A, Caballeria L, Bruguera M, Caballeria J, Ballesta AM, Rodes J. Serum hyaluronate
, http://www.100md.com
reflects hepatic fibrogenesis in alcoholic liver disease and is useful as a marker of fibrosis. Hepatology
1996;24:1399-1403
13 Lai CL, Ratziu V, Yuen MF, Poynard T. Viral hepatitis B. Lancet 2003;362:2089-2094
14 Niederau C, Heintges T, Lange S, Goldmann G, Niederau CM, Mohr L, Haussinger D. Long-term follow-up of
HBeAg-positive patients treated with interferon alfa for chronic hepatitis B. N Engl J Med 1996;334:1422-1427
编辑 张海宁, 百拇医药( 韩群英,刘正稳, 张 妮, 朱凤群)
