阿糖腺苷合并甘草甜素治疗慢性乙型肝炎临床观察

本文报道42例慢性活动性乙型肝炎患者(全部病例经肝活组织检查证实),随机分成3组:甲组20例,采用甘草甜素治疗;乙组10例,采用阿糖腺苷治疗;丙组12例先用甘草甜素治疗1个疗程,后用阿糖腺苷治疗1个疗程,其中3例各用两个疗程。结果3组的疗效达到Ⅰ级与Ⅱ级者分别为:甲组3例(15%),乙组2例(20%),丙组5例(42%),丙组中应用两个疗程者3例,其中2例疗效为Ⅰ级,1例为Ⅱ级。故认为阿糖腺苷与甘草甜素合用可明显提高疗效,且以多疗程治疗为佳。

英文摘要:

Chronic active hepatitis(CAH)is a kind of disease that frequently led to the cirrhosis of liver and hepatic failure.One of the pathogenetic factor is thought to be the continuous replication of the HBV.Therefore,antiviral therapy has been studied in clinical practice.42 patients suffering from CAH caused by HBV have been hospitalized during the period of June 1985 to March 1986.The diagnosis was confirmed pathologically with liver biopsy.Their ages ranged from 18 to 42(average 31).37 were males and 5 females.The patients were HBsAg positive for 2～12 years with an average of 5.6 years.The 42 patients were divided into 3 groups:Group A,20 patients receiving Glycyrrhizin (Stronger Neo-Minophagen C),30 days as a course;Group B,10 patients receiving a course(28 days) of Adenine Arabinose(Ara-A);Group C,12 patients receiving a course of Glycyrrhizin,followed by a course of Ara-A,but 3 of group C receiving two courses each.The therapeutical effect was measured by the disappearance of detectable HBsAg, HBeAg,DNA polymerase(DNAP)and HBV-DNA levels in serum.Randomized controlled study showed that the 3 groups of patients’ negative conversion rate of HBeAg,HBV-DNA and DNAP in serum during treatment were 3/20 (15%),2/10(20%)and 5/12(42%)respectively.Two of the group C remained continuous negative of HBeAg,HBV-DNA,DNAP 6 months after treatment.Suppression of HBV replication was associat- ed with pathological evidence of improvement in liver biopsy;there was also reduction in inflamma- tory activity.The results showed that those receiving combined therapy of Ara-A with Glycyrrhizin revealed better therapeutic effect than using Ara-A or Glycyrrhizin alone on the clearance of HBeAg,DNAP,HBV-DNA.The difference was statistically significant. This study confirmed that combination of Ara-A with Glycyrrhizin was effective in yielding long-term suppression of HBV replication in some CAH patients.On a large-scale randomized controlled studies,many factors might influence the outcome of treatment,an optimal regime of therapy for difference is necessary.

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