| 血清cccDNA在阿德福韦酯治疗慢性乙型肝炎中的临床研究 |
| Alternative Title | The clinical research of serum cccDNA in treat ment of Adefovir Dipivoxil to the Chronic Hepatitis B
|
| 冯钧帅 |
| Thesis Advisor | 陈青锋
|
| 2010-05-26
|
| Degree Grantor | 兰州大学
|
| Place of Conferral | 兰州
|
| Degree Name | 硕士
|
| Keyword | 血清cccDNA
阿德福韦酯
应答
预测作用
|
| Abstract | 目的 探讨血清cccDNA在阿德福韦酯治疗慢性乙型肝炎中的临床价值，以明确血清cccDNA的临床意义。
方法 选取81例确诊CHB患者，所有患者给予阿德福韦酯治疗（口服10mg/次,1日1次），对所有病例的血清cccDNA进行检测，根据血清cccDNA检测结果，将81例CHB患者分为cccDNA阳性组和cccDNA阴性组，所有病例每24周随访一次，连续随访4次，治疗前及随访时检测HBVDNA、HBsAg、HBs-Ab、HBeAg、 HBe-Ab和HBc-Ab病毒学指标及ALT等生化指标，然后对两组的指标进行比较。
结果：两组在年龄及性别比较无统计学意义（P＞0.05）。cccDNA阳性组血清的cccDNA与HBVDNA、HBeAg及ALT的Spearman秩相关系数分别是0.756、0.647及0.550，血清cccDNA与HBVDNA、HBeAg及ALT呈正相关性。随访24和48周时cccDNA阳性组和阴性组HBVDNA转阴率、e系统的血清学转换率及ALT复常率比较无统计学意义（P＞0.05）, 随访72周时HBVDNA转阴率和e系统血清学转换率比较有统计学意义（P＜0.05）,ALT复常率比较无统计学意义（P＞0.05）,随访96周时HBVDNA转阴率（34.14%vs59.46%,χ2=5.014）、HBeAg阴转率（21.95% vs48.64%,χ2 =6.125）、HBe-Ab阳转率（19.51%vs40.54%,χ2=4.136）及ALT复常率（87.80%vs100.00%,χ2=2.370）比较有统计学意义（P＜0.05）。两组在接受ADV治疗过程中HBVDNA的中位数随着治疗时间的延长而下降，cccDNA阴性组下降较cccDNA阳性组明显；HBeAg于基线和24周时两组之间比较无统计学意义（P＞0.05），于48周、72周及96周时两组之间比较有统计学意义（P＜0.05），48周后两组与各自基线有统计学意义（P＜0.05）；ALT于基线、24周及48周时两组比较无统计学意义（P＞0.05），48周后两组与各自基线比较有统计学意义（P＜0.05），两组间在72周及96周比较有统计学意义（P＜0.05）。随着治疗延长，cccDNA阴性组的在病毒、血清及生化学应答明显高于cccDNA阳性组。
结论：随着阿德福韦酯治疗时间的延长，HBVDNA载量、HBeAg滴度及ALT下降，同时HBVDNA转阴率、e系统血清学转换率逐渐增高。阿德福韦酯能够有效抑制病毒复制，而且阴性组在病毒学、血清学及生化应答方面高于阳性组，因此，血清cccDNA对阿德福韦酯远期疗效有一定预测作用。 |
| Other Abstract | Objective To investigate the clinical value of serum cccDNA in treatment of Adefovir Dipivoxil to the Chronic Hepatitis B.
Methods Eighty-one patients with Chronic Hepatitis B was internalized by the standard condition，which received Adefovir Dipivoxil (ADV) treatment by taking one to 10mg daily. These patients were divided into cccDNA positive and negative groups by detecting serum cccDNA. HBVDNA, HBeAg, HBe-Ab and ALT were detected in all patient serum before ADV treatment and till ADV treatment week 24,48,72 and 96.
Results Two groups were not significantly different in age and gender（P＞0.05）. Spearman rank correlation between serum cccDNA and HBVDNA, HBeAg and ALT were 0.756,0.647 and 0.550 respectively before ADV treatment, therefore, serum cccDNA is positively correlated with those virological and biochemical parametes. Two groups were not significantly different in negative rate of HBVDN A,e-system seroconversion and normalization rate of ALT at week 24 and 48（P＞0.05）. They were significantly different in negative rate of HBVDNA and e-system seroconversion at week 72（P＜0.05）, except normalization rate of ALT（P＞0.05）. They were significantly different in negative rate of HBVDNA（34.14%vs59.46%,χ2=5.014）,negative rate of HBeAg（21.95% vs 48.64%,χ2=6.125）,positive rate of HBe-Ab（19.51%vs40.54%,χ2=4.136）and normalization rate of ALT（87.80%vs100.00%χ2=2.370）at ADV treatment week 96（P＜0.05）. Median of HBVDNA had decreased gradually, especially cccDNA negative group, with prolongation of the treatment. Two groups was significantly different in decrease of HBeAg at week 48,72 and 96（P＜0.05）. except baseline and week 24（P＞0.05）. Two groups was not significantly different in decrease of ALT at baseline and week 24 and 48（P＞0.05）, except week 72 and 96（P＜0.05）.Therefore,with prolongation of treatment , response of cccDNA negative group was higher obviously than cccDNA negative group in virology, serology and biochemistry.
Conclusion With prolonging treatment，ADV is effective in clearance of HBVDNA and decrease of HBeAg and ALT, cccDNA negative group decreased faster than cccDNA postive group. Therefore serum cccDNA is predictive value as ADV treatment to Chronic Hepatitis B. |
| URL | 查看原文
|
| Language | 中文
|
| Document Type | 学位论文
|
| Identifier | https://ir.lzu.edu.cn/handle/262010/222424
|
| Collection | 学院待认领
|
| Affiliation | 临床医学院
|
Recommended Citation
GB/T 7714 |
冯钧帅. 血清cccDNA在阿德福韦酯治疗慢性乙型肝炎中的临床研究[D]. 兰州. 兰州大学,2010.
|
Items in the repository are protected by copyright, with all rights reserved, unless otherwise indicated.
