Shin J W, Park N H, Park J H, Park J H, Jeong I D, Bang S-J, Joo K R, Kim D H
Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea.
J Viral Hepat. 2005 Jul;12(4):393-7. doi: 10.1111/j.1365-2893.2005.00606.x.
The efficacy of lamivudine re-treatment in chronic hepatitis B (CHB) patients who relapse after HBeAg seroconversion with lamivudine has not been investigated. The aim of this study was to evaluate the efficacy of lamivudine re-treatment in relapsed patients. Among 192 patients who had achieved HBeAg seroconversion with lamivudine at a dose of 100 mg/day, 121 patients discontinued lamivudine. Relapse occurred in 49 patients (40.5%). Thirty-three relapsed patients received lamivudine re-treatment for at least 6 months. The mean duration of lamivudine re-treatment was 16 months and the follow-up period was 8.9 months. HBeAg seroconversion was achieved in 23 patients (69.7%). The cumulative HBeAg seroconversion rates at 5, 9, and 12 months were 60, 64, and 67%, respectively. The mean time to HBeAg seroconversion in lamivudine re-treatment was shorter than that in the initial therapy (4.7 months vs. 9.7 months). Viral breakthrough occurred in six (18.2%) patients. All patients with viral breakthrough were accompanied by elevation of serum alanine aminotransferase (ALT) levels. Among 15 patients who discontinued lamivudine re-treatment after HBeAg seroconversion, relapse occurred in six patients (40%). All relapses occurred within 9 months after the discontinuation of lamivudine re-treatment. In conclusion, lamivudine re-treatment in relapsed patients after initial lamivudine therapy had a higher response rate and shorter duration to HBeAg seroconversion than during the initial therapy. However, HBeAg seroconversion induced by lamivudine re-treatment was not durable.
对于在使用拉米夫定实现HBeAg血清学转换后复发的慢性乙型肝炎（CHB）患者，拉米夫定再治疗的疗效尚未得到研究。本研究的目的是评估拉米夫定再治疗对复发患者的疗效。在192例接受每日100mg剂量拉米夫定治疗并实现HBeAg血清学转换的患者中，121例停用了拉米夫定。49例（40.5%）出现复发。33例复发患者接受了至少6个月的拉米夫定再治疗。拉米夫定再治疗的平均持续时间为16个月，随访期为8.9个月。23例患者（69.7%）实现了HBeAg血清学转换。5、9和12个月时的累积HBeAg血清学转换率分别为60%、64%和67%。拉米夫定再治疗中HBeAg血清学转换的平均时间短于初始治疗（4.7个月对9.7个月）。6例（18.2%）患者出现病毒突破。所有发生病毒突破的患者均伴有血清丙氨酸氨基转移酶（ALT）水平升高。在15例HBeAg血清学转换后停用拉米夫定再治疗的患者中，6例（40%）复发。所有复发均发生在停用拉米夫定再治疗后的9个月内。总之，初始拉米夫定治疗后复发患者的拉米夫定再治疗比初始治疗具有更高的应答率和更短的HBeAg血清学转换时间。然而，拉米夫定再治疗诱导的HBeAg血清学转换并不持久。
