만성 B병 바이러스성 간질환에서 라미부딘의 효과

초록

Background/Aims: Lamivudine has demonstrated a potent suppression of viral replication and a substantial histologic improvement in many patients with chronic hepatitis B. This study is intended to evaluate the effects of lamivudine and the breakthrough rate in patients with HBV associated chronic liver diseases including decompensated liver cirrhosis, and to investigate the clinical factors closely related with these events. Methods: A total of 58 patients(chronic hepatitis 21, cirrhosis 37) showing abnormal serum levels of aminotransferase and detectable serum HBV DNA for at least 6 month received 150 mg of lamivudine once a day for 3-27 months (median 13). The Kaplan-Meier methods and the Cox regression model were used for statistic analysis. Results: The one-year cumulative incidences of the negative conversion of serum HBV DNA, normalization of aminotransferase, and seroconversion of HBeAg were 98.3%, 86.2% and 20.6%, respectively. Eighteen-month and 2-year cumulative breakthrough rates were 24% and 47%, respectively. The Child-Pugh scores were improved (p<0.001) in patients with decompensated liver cirrhoses(n=21). The negative conversion of HBV DNA, breakthrough rates and seroconversion were not significantly associated with the progression of disease, mutation in pre-core region and previous treatment with interferon. The pre-treatment aspartate aminotransferase (AST) level was associated with a higher rate of seroconversion(p<0.03). Conclusion: Despite a higher breakthrough rate, 2-year lamivudine treatment has induced the seroconversion of HBeAg in 26% of patients, and improved the clinical manifestations in decompensated cirrhotic patients.

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