Yao F Y, Bass N M
Department of Transplantation, California Pacific Medical Center, San Francisco 94143-0538, USA.
J Hepatol. 2000 Aug;33(2):301-7. doi: 10.1016/s0168-8278(00)80371-2.
BACKGROUND/AIMS: Lamivudine is highly effective in suppressing hepatitis B viral replication and hepatic necroinflammatory activity. The potential for recovery of hepatic decompensation in patients with chronic hepatitis B infection treated with lamivudine has not been established. The aim of this study was to evaluate the effectiveness of lamivudine treatment in severely decompensated cirrhosis due to chronic hepatitis B.
Thirteen consecutive patients with chronic hepatitis B infection, Child's-Pugh-Turcotte (CPT) score of > or =10 (median score=11) and detectable circulating hepatitis B DNA (range 15 to 9634 pg/ml) were included and treated with lamivudine 150 mg once daily. Hepatitis B envelope antigen (HBeAg) was positive in 9 of 13 patients pre-treatment.
Two patients underwent liver transplantation at 4 and 6 weeks after starting lamivudine treatment. The remaining 11 patients were followed for a mean of 17.5 months without liver transplantation (range 3 to 39 months). Significant improvement of liver function, defined as a decrease in CPT score of > or =3, was observed in 9 of 13 patients (69%). In five patients, CPT score improved to <7 and they were placed on the inactive status (UNOS status 7) for liver transplantation. Hepatitis B DNA remained negative in all except one patient who developed breakthrough viral replication 12 months after starting lamivudine treatment, while maintaining stable liver function. Three of seven HBeAg-positive patients who did not undergo liver transplantation lost HBeAg during follow-up, but none had sustained seroconversion to hepatitis B e antibody.
Lamivudine appears highly effective in reversing severe hepatic decompensation due to replicating hepatitis B infection.
背景/目的：拉米夫定在抑制乙型肝炎病毒复制和肝脏坏死性炎症活动方面非常有效。拉米夫定治疗慢性乙型肝炎感染患者时肝脏失代偿恢复的可能性尚未确定。本研究的目的是评估拉米夫定治疗慢性乙型肝炎所致严重失代偿性肝硬化的有效性。
纳入13例连续的慢性乙型肝炎感染患者，其Child's-Pugh-Turcotte（CPT）评分≥10（中位数评分=11）且可检测到循环乙型肝炎DNA（范围为15至9634 pg/ml），给予每日1次150 mg拉米夫定治疗。13例患者中有9例治疗前乙型肝炎e抗原（HBeAg）呈阳性。
2例患者在开始拉米夫定治疗后4周和6周接受了肝移植。其余11例患者未进行肝移植，平均随访17.5个月（范围为3至39个月）。13例患者中有9例（69%）观察到肝功能显著改善，定义为CPT评分降低≥3。5例患者CPT评分改善至<7，被列入肝移植的非活动状态（UNOS状态7）。除1例患者在开始拉米夫定治疗12个月后出现病毒突破复制外，所有患者的乙型肝炎DNA均保持阴性，同时肝功能保持稳定。7例未进行肝移植的HBeAg阳性患者中有3例在随访期间失去了HBeAg，但均未持续血清学转换为乙型肝炎e抗体。
拉米夫定在逆转因乙型肝炎感染复制所致严重肝脏失代偿方面似乎非常有效。
