不同形式乙型肝炎的促效治疗

E. N. Priima, A. D. Bushmanova, K. E. Novak, E. Esaulenko
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摘要

背景。目前,乙型肝炎的致病因治疗在大多数情况下是使用核苷类似物进行的。治疗的最终目的取决于给药的时间——急性或慢性肝炎。乙型肝炎病毒的分子遗传谱对急性和慢性乙型肝炎治疗有效性的影响尚未确定,这需要进一步研究。目标。评估现代致病因治疗急性和慢性乙型肝炎的可能性。本文分析了接受核苷类似物致病因治疗患者的临床指标、实验室指标和仪器数据。结果。致病因治疗导致所有患者的病毒载量下降到无法检测的水平,无论乙肝病程如何,感染的是“突变”病毒株还是“野生”病毒株。在急性乙型肝炎中,治疗24周后没有100%的病例检测到HBV DNA,治疗36周后HBsAg血清转化;慢性乙型肝炎- 36周后无HBsAg血清转化。治疗结束6个月后,89.7%的慢性乙型肝炎患者复发,但病毒载量低于2000 IU / ml,肝纤维化严重程度不显著。在其余病例中,需要恢复治疗。结论。研究发现,乙型肝炎病毒的突变不影响致病因治疗的有效性。病毒载量下降率与乙型肝炎的形式相关,在急性疾病中明显更高。
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ETIOTROPIC THERAPY FOR DIFFERENT FORMS OF HEPATITIS B
Background. Currently, etiotropic therapy of hepatitis B in most cases is carried out using nucleot(s)ide analogues. The ultimate goal of the therapy depends on the period of its administration – in acute or chronic hepatitis. The influence of the molecular genetic profile of the hepatitis B virus on the effectiveness of therapy in both acute and chronic forms of the disease has not yet been established, which requires further research. Objective. To assess the possibilities of modern etiotropic therapy in acute and chronic forms of hepatitis B. Material and methods. The article analyzes the indicators of clinical, laboratory and instrumental data of patients who received etiotropic therapy with nucleot(s)ide analogues. Results. Etiotropic therapy resulted in a viral load decrease to an undetectable level in all patients regardless of the course of hepatitis B and infection with either a "mutant" or "wild" virus strain. In acute hepatitis B, HBV DNA was not detected in 100% of cases after 24 weeks of therapy, in HBsAg seroconversion - after 36 weeks; in chronic hepatitis B - after 36 weeks without HBsAg seroconversion. Six months after the completion of the treatment, the patients with chronic hepatitis B developed relapse in 89.7% of cases, but the viral load was less than 2000 IU / ml, and the severity of liver fibrosis was insignificant. In the rest of the cases, resumption of therapy was required. Conclusions. It was found that mutations of the hepatitis B virus do not affect the effectiveness of etiotropic therapy. The rate of viral load decrease correlates with the form of hepatitis B and is significantly higher in acute disease.
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