Suzuki Yoshiyuki, Arase Yasuji, Ikeda Kenji, Saitoh Satoshi, Tsubota Akihito, Suzuki Fumitaka, Kobayashi Masahiro, Akuta Norio, Someya Takashi, Miyakawa Yuzo, Kumada Hiromitsu
Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan.
Intervirology. 2003;46(3):164-70. doi: 10.1159/000071457.
The long-term effects of lamivudine and the influence of YMDD mutants on the histology of chronic hepatitis B are not known.
3-year lamivudine therapy was given to 16 patients with chronic hepatitis B. YMDD mutants did not develop in 9 patients (group A), while they appeared in the remaining 7 patients (group B).
Biochemical and virological responses were invariably achieved in the 9 patients without YMDD mutants, while virological breakthroughs with or without biochemical relapses occurred in all 7 patients with such mutants. All 16 patients accomplished histological improvement, with the total histology activity index (HAI) score decreasing from 11.3 +/- 3.0 to 4.1 +/- 1.7 (p < 0.001). The total HAI score decreased from 11.6 +/- 3.8 to 3.4 +/- 1.3 in the 9 patients in group A (p < 0.001). Although to a significantly lesser extent (p < 0.02), the total HAI score also decreased in the 7 patients in group B from 10.9 +/- 1.0 to 5.0 +/- 1.7 (p < 0.001).
The results obtained indicate that 3-year lamivudine therapy can induce histological improvements, regardless of the appearance of YMDD mutants accompanied by virological breakthroughs and biochemical relapses.
拉米夫定的长期疗效以及YMDD突变体对慢性乙型肝炎组织学的影响尚不清楚。
对16例慢性乙型肝炎患者进行了3年的拉米夫定治疗。9例患者（A组）未出现YMDD突变体，而其余7例患者（B组）出现了YMDD突变体。
9例未出现YMDD突变体的患者均实现了生化和病毒学应答，而所有7例出现此类突变体的患者均发生了有或无生化复发的病毒学突破。所有16例患者均实现了组织学改善，组织学总活动指数（HAI）评分从11.3±3.0降至4.1±1.7（p<0.001）。A组9例患者的HAI总分从11.6±3.8降至3.4±1.3（p<0.001）。B组7例患者的HAI总分也从10.9±1.0降至5.0±1.7（p<0.001），尽管程度明显较轻（p<0.02）。
所得结果表明，3年的拉米夫定治疗可诱导组织学改善，无论是否出现伴有病毒学突破和生化复发的YMDD突变体。
