Kawaoka Tomokazu, Suzuki Fumitaka, Akuta Norio, Suzuki Yoshiyuki, Arase Yasuji, Sezaki Hitomi, Kawamura Yusuke, Hosaka Tetsuya, Kobayashi Masahiro, Ikeda Kenji, Kumada Hiromitsu
Department of Hepatology, Toranomon Hospital, 2-2-2 Toranomon, Tokyo 105-8470, Japan.
J Gastroenterol. 2007 May;42(5):395-401. doi: 10.1007/s00535-007-2015-2. Epub 2007 May 25.
The aim of this study was to evaluate the efficacy of lamivudine therapy in elderly patients with chronic HBV infection.
Patients aged >or=60 years (n = 40) received lamivudine monotherapy between February 1995 and September 2005 at Toranomon Hospital. We compared the efficacy of lamivudine therapy in these patients and in 639 patients aged <60 years, including 80 patients aged <60 years matched for sex, hepatitis B e antigen (HBeAg) status, and hepatitis B virus (HBV) DNA level.
The rates of normalization of alanine aminotransferase (ALT) level in 40 patients aged >or=60 years and 639 patients aged <60 years were 85% versus 76%, and 86% versus 73% at 1 and 3 years, respectively. The respective rates of loss of HBV-DNA were 74% versus 74%, and 76% versus 68% at 1 and 3 years. The respective cumulative emergence rates of the YMDD mutant were 16% and 17% at 1 year, and 46% and 49% at 3 years. In 80 patients <60 years old matched for sex, HBeAg status, and HBV-DNA level, the rates of normalization of the ALT level and loss of HBV-DNA were similar to those in the 639 patients aged <60 years. The emergence rate of YMDD mutants in patients aged >or=60 years were similar to those in matched patients aged <60 years. Multivariate analyses identified low serum bilirubin (<1 mg/dl) as an independent factor associated with the emergence of the YMDD motif mutation in patients aged >or=60 years.
Our results suggest that treatment with lamivudine is both well tolerated and efficacious in elderly patients with chronic HBV infection.
本研究旨在评估拉米夫定治疗老年慢性乙型肝炎病毒（HBV）感染患者的疗效。
1995年2月至2005年9月期间，60岁及以上患者（n = 40）在虎之门医院接受拉米夫定单药治疗。我们比较了这些患者与639名60岁以下患者（包括80名在性别、乙肝e抗原（HBeAg）状态和乙肝病毒（HBV）DNA水平方面匹配的60岁以下患者）的拉米夫定治疗效果。
40名60岁及以上患者和639名60岁以下患者的丙氨酸氨基转移酶（ALT）水平正常化率在1年和3年时分别为85%对76%，以及86%对73%。HBV-DNA转阴率在1年和3年时分别为74%对74%，以及76%对68%。1年时YMDD突变体的累积出现率分别为16%和17%，3年时分别为46%和49%。在80名在性别、HBeAg状态和HBV-DNA水平方面匹配的60岁以下患者中，ALT水平正常化率和HBV-DNA转阴率与639名60岁以下患者相似。60岁及以上患者中YMDD突变体的出现率与匹配的60岁以下患者相似。多因素分析确定低血清胆红素（<1mg/dl）是60岁及以上患者中与YMDD基序突变出现相关的独立因素。
我们的结果表明，拉米夫定治疗老年慢性HBV感染患者耐受性良好且有效。
