A Study On The Clinical And Pathological Efficacy Of Lamivudine In The Treatment Of Chronic Hepatitis B

Objective To investigate serum HBV markers changes,HBeAg seroconversoin,normalization rate of ALT,liver pathohistological changes(including pathology,HBV markers and apoptosis in liver tissue) in　patients with chronic hepatitis B after 52 weeks therapy with lamivudine．Methods 70　patients　of chronic　hepatitis　B had　51 men and 19 women,They were 12-48 years old(average 26.2±7.436 years old),including 4 patients who have α mutation in the　precore　regine of the genome and 10 HBV carriers． All patients were randomly selected and administered　100mg　Lamivudine orally daily for 52 weeks,The serum HBV-DNA,HBeAg/HBeAb and hepatic chemistry were studied at pretreatment and 3,6,12 months after treatment,and the hepatic fibrosis markers also studied before and after treatment,The needle biopsy of liver were performed in 35 patients before and after treatment． the routine HE stained liver tissue sections were evaluated and Knodell pathological score were done． HBsAg,HBcAg,　α-SMA and Fas antigen in liver tissue were examined by immunohistochemisty method．Results After 3 months treatment with lamivudine the level of HBVDNA descented rapidly,after 1 year the negative　conversion　rate of serum HBV-DNA,the seroconversion rate of HBeAg and normalization rate of ALT were 93.22%,21.82% and 69.39%,None of HBV carriers had seroconversion of HBeAg,the patients in whom HBeAg seroconversion　had higher base-line　alanine　aminotransferase levels than the patients　without seroconversion． the serum hyaluronidase and type ?V collogen levels decreased significantly,laminin and type Ш collogen showed no obvious alteration after lamivudine treatment．histological assessment revealed that necrosis in portal area,pylenphlebitis and fibrosis were obovious alleviated,but no significant improvement in intralobular inflammation was observed。Activity index of hepatic histology in 41.18% patients(14/34) had a significant decrease．Theliver immunohistochemistry examination showed HBcAg and α-SMA in liver decreased　significantly in the patients with HBeAg　seroconversion,HBsAg had no obvious alteration,but the patients without seroconversion showed no obvious decreased in HBsAg,HBcAg and α-SMA． Fas antigen decreased significantly．No severe drug related side effects were reported during treatment． Conclusions These results suggested that lamivudine(100mg/d) could suppress HBV-DNA replication,promote ALT normalization,accelerate HBeAg/anti-Hbe seroconversion,improve the liver pathological changes,alleviate the inflammation degree,slow down the development of liver fibrosis．Lamivudine is a effective compound with high safety and low side effect in the treatment of chronic hepatitis Β．...