Kurihara Tomoko, Imazeki Fumio, Yokosuka Osamu, Fukai Kenichi, Kanda Tatsuo, Kawai Shigenobu, Saisho Hiromitsu
Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuou Ward, Chiba 260-8670, Japan.
World J Gastroenterol. 2005 Jun 14;11(22):3346-50. doi: 10.3748/wjg.v11.i22.3346.
To clarify differences in antiviral effect of the drug in patients with different ALT levels, we examined the changes in HBV markers in patients with high or low ALT levels with or without lamivudine treatment.
Thirty-seven HBeAg-positive patients were studied. Ten patients with ALT levels higher than 200 IU/L (group 1) and 8 patients with ALT below 200 IU/L (group 2) were treated orally with 100 mg/d of lamivudine. As untreated control, 9 patients with ALT above 200 IU/L (group 3) and 10 patients with ALT below 200 IU/L (group 4) were examined. ALT level, HBeAg/HBeAb status, and HBV DNA level were examined monthly for 11.9+/-0.4 mo.
The ALT level normalized in all 10 patients of group 1, 7/8 of group 2, 4/9 of group 3, and 1/10 of group 4 within 6 mo (groups 1 vs 2, P = NS; groups 1 vs 3, P = 0.002; groups 1 vs 4, P<0.0001). HBV DNA fell below the detection limit in all 10 patients of group 1, 7/8 of group 2, 0/9 of group 3, and 0/10 of group 4 within 6 mo (groups 1 vs 2, P = NS). HBeAg became seronegative in 7/10 patients of group 1, 1/8 of group 2, 3/9 of group 3, and 0/10 of group 4 within 12 mo (groups 1 vs 2, P = 0.02; groups 1 vs 3, P = NS).
Our data suggest that HBeAg-positive patients with higher ALT levels can be considered good candidates for lamivudine therapy, probably because lamivudine accelerates the natural seroconversion of HBeAg, accompanied by HBV DNA loss, in these patients.
为阐明该药物在不同丙氨酸氨基转移酶（ALT）水平患者中的抗病毒效果差异，我们研究了接受或未接受拉米夫定治疗的高或低ALT水平患者乙肝病毒（HBV）标志物的变化。
研究了37例HBeAg阳性患者。10例ALT水平高于200 IU/L的患者（第1组）和8例ALT水平低于200 IU/L的患者（第2组）口服100 mg/d拉米夫定。作为未治疗对照，检查了9例ALT高于200 IU/L的患者（第3组）和10例ALT低于200 IU/L的患者（第4组）。每月检查ALT水平、HBeAg/HBeAb状态和HBV DNA水平，持续11.9±0.4个月。
第1组的所有10例患者、第2组的7/8患者、第3组的4/9患者和第4组的1/10患者在6个月内ALT水平恢复正常（第1组与第2组，P =无显著性差异；第1组与第3组，P = 0.002；第1组与第4组，P<0.0001）。第1组的所有1例患者、第2组的7/8患者、第3组的0/9患者和第4组的0/10患者在6个月内HBV DNA降至检测限以下（第1组与第2组，P =无显著性差异）。第1组的7/10患者、第2组的1/8患者、第3组的3/9患者和第4组的0/10患者在12个月内HBeAg转为血清学阴性（第1组与第2组，P = 0.02；第1组与第3组，P =无显著性差异）。
我们的数据表明，ALT水平较高的HBeAg阳性患者可被视为拉米夫定治疗的良好候选者，可能是因为拉米夫定加速了这些患者中HBeAg的自然血清学转换，并伴有HBV DNA丢失。
