Predictiors Of Response In Patients With HBeAg-positive Chronic Hepatitis B With Adefovir Dipivoxil Treatment

[Objective]To observe the efficacy of Adefovir dipivoxil(ADV)monotherapy for HBeAg positive patients with chronic hepatitis B,evaluate the influence of baseline ALT and HBV DNA level on biochemical and virological response of Adefovir dipivoxil monotherapy,evaluate relationship between CD4⁺/CD8⁺ ratio change during treatment to response of Adefovir dipivoxil monotherapy.Try to find useful predictors of Adefovir dipivoxil monotherapy to HBeAg positive chronic hepatitis B patients.[Methods]90 patients with chronic hepatitis B who were positive for HBeAg were collected for this study.Baseline ALT＜2×ULN were 18 cases,2-5×ULN were 35 cases,5-10×ULN were 37 cases;HBV DNA 10⁵-10⁷ copies/ml were 51 cases,HBV DNA≥10⁷copies/ml were 39 cases.Each patients were treated with Adefovir dipivoxil monotherapy.Liver function,renal function,HBV DNA,HBsAg,HBeAg,anti-HBc, anti-HBe,anti-HBs,BCA,Urine routine were detected at baseline,12 weeks,24 weeks and 48 weeks after treatment respectively.CD4⁺/CD8⁺ ratio was also detected. Full response was defined by HBV DNA negative,HBeAg seroconversion,ALT normalization.Partial response was defined by HBV DNA negative or inhibited by more than 2 log₁₀copies/ml,no HBeAg seroconversion,ALT normalization.No response HBV DNA was inhibted less than 2 log₁₀copies/ml,HBeAg still positive, ALT abnormal.[Results]After being treated with adefovir dipivoxil monotherapy for 48 weeks,71.1% HBeAg positive patients with chronic hepatitis B develpoed ALT normalization.The serum HBV DNA negative rate was 50.0%,HBeAg seroconversion rate was 12.2%.If baseline ALT level＜2×UNL,ALT normalization rate was 38.9%,HBV DNA negative rate was 11.1%,HBeAg negative rate was 5.5%and seroconversion rate was 0%after been treated with adefovir dipivoxil monotherapy for 48 weeks.If baseline ALT was 2-5×ULN,ALT normalization rate was 68.6%,HBV DNA negative rate was 45.7%,HBeAg negative rate was 28.6%and seroeonversion rate was 8.6%after been treated with adefovir dipivoxil monotherapy for 48 weeks.If baseline ALT was 5-10×ULN ALT normalization rate was 89.2%,HBV DNA negative rate was 73%,HBeAg negative rate was 45.9%and seroconversion rate was 21.6%after been treated with adefovir dipivoxil monotherapy for 48 weeks.If baselin HBV DNA was 10⁵-10⁷copies/ml,ALT normalization rate was 82.4%,HBV DNA negative rate was 60.8%and seroconversion rate was 15.7%respectively after been treated with adefovir dipivoxil monotherapy for 48 weeks.If baseline HBV DNA≥10⁷copies/ml,ALT normalization rate was 56.4%,HBV DNA negative rate was 35.9%and seroconversion rate was 7.7%respectively after been treated with adefovir dipivoxil monotherapy for 48 weeks.Patients ages and sex has no influence on adefovir dipivoxil treatment result.All patients showed low CD4⁺/CD8⁺ T lymphocytes ratio.After been treated with adefovir dipivoxil treatment for 24 weeks,CD4⁺/CD8⁺ T lymphocytes ratio of response group was 1.46±0.21,and non response group was 1.37±0.17.90 cases HBeAg positive Hepatitis B patients have been treated with adefovir dipivoxil monotherapy for 48 weeks,full response rate was 12.2%,partial response rate was 75.6%,non response rate was 12.2%.The response rate in patients whose ALT level was 2-5×ULN and 5-10×ULN at baseline was higher than patients whose ALT level was less than 2×ULN.Also the response rate in patients whose HBV DNA level was 10⁵-10⁷ copies/ml was higher than patients whose HBV DNA level was more than 10⁷ copies/ml.[Conclusion]1.For HBeAg positive patients with chronic hepatitis B,48 weeks adefovir dipivoxil monotherapy was safe and economic and resulted in good virological and biochemical improvements if patients with higher baselin ALT level and low HBV DNA level were selected.2.Patients whose baseline ALT level was more than 2×ULN,HBV DNA was less than 10⁷ copies/ml were good predictors for adefovir dipivoxil monotherapy.3.CD4⁺/CD8⁺ ratio increased during adefovir dipivoxil monotherapy for 24 week was also a good predictor.