Rafet METE, Mustafa ORAN, Kürşat TÜRKDOĞAN

Kronik Hepatit B Tedavisinde Pegile İnterferon Alfa ile Lamivudin Monoterapilerinin Karşılaştırılması

Amaç: Bu çalışmada, HBeAg pozitif ve HBeAg negatif kronik hepatit B hastalarında Lamivudin (LAM) monoterapisi ile Pegile-interferon alfa (PEG-IFNα) monoterapisi etkinliklerinin karşılaştırılması amaçlanmıştır. Materyal ve Metod: Bu çalışmaya 2003-2007 yılları arasında Yüzüncü Yıl Üniversitesi Tıp Fakültesi Gastroenteroloji kliniğine başvuran ve kronik hepatit B infeksiyonu tanısı konup tedavi edilen toplam 61 hastanın tedaviye cevapları retrospektif olarak incelendi.16 hasta HBeAg pozitif, 45 hasta HBe Ag negatifti. 34 hastaya (HBeAg-pozitif = 8, HBeAg-negatif= 26) Lamivudin (LAM) monoterapisi ortalama 24.4±2.3 ay ve 27 hastaya (HBeAg-pozitif = 8, HBeAg-negatif = 19) Pegileinterferon alfa (PEG-IFNα) monoterapisi 12±0 ay verildi ve her iki grup tedavi sonrası 6 ay izlendi. Bulgular: İki tedavi grubu için yaşlar arasında istatistiksel olarak fark yoktu (LAM grubu:39.8, PEG-IFNα:38.2, p>0,05 ). Her iki tedavi grubunda HBeAg pozitifliği oranları arasında fark istatistik olarak anlamlı değildi (p>0,05). iki tedavi grubu arasında HAİ ve FİB özelliklerinin ortancaları (Medyanları) arasında istatistiksel olarak anlamlı fark yoktu (p>0,05). Tedavi öncesi HBV DNA düzeyleri; HBeAg pozitif hastalarda 105 kopy/ml, negatiflerde 104 kopy/ml den yüksek olan tüm hastalar tedavi kriteri taşımaktaydı. Tedavi öncesi hastaların ortalama ALT düzeyi 129.0±15,5 olup başlangıçtaki ALT ortalamaları iki grup arasında farklı değildi (p>0,05). Sonuç: LAM ve PEG-IFNα tedavileri arasında kalıcı cevap benzerdir ve gruplar arasında istatistik olarak fark oluşturmamıştır Literatürle karşılaştırıldığında bu çalışmada başarı oranı daha fazla olmakla beraber anlamlı fark yoktu. Başarı oranımızdaki bu yüksekliği tedavi sonu izlem süremizin kısa olması ve hasta uyumunun tam olmasından kaynaklandığına bağlayabiliriz.

Anahtar Kelimeler:

Kronik Hepatit B, peg-IFN, lamivudin

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Aim This study aims to compare the efficacy of lamivudine (LAM) and interferon alpha (PEG-IFNα) monotherapies in HBeAg positive and HBeAg negative chronic hepatitis B. Materials and Methods This study was carried out between the years 2003 and 2007 at the Medicine Faculty of Yuzuncu Yil University (YYU). Totally, 61 patients, who applied to the Gastroentrolgy Clinic at YYU have been diagnosed as chronic hepatitis B, and their responses to the treatment were retrospectively analyzed. Whereas sixteen patients had HBeAg positive, 45 patients had HBeAg negative. Lamivudin (LAM) mono-therapy, an avarage 24.4 ± 2.3 months, has been given to the 34 patients (HBeAg positive=8, HBeAg negative=26), PEG-IFNα monoterapy, an avarage 12±0 months, has been given to the 27 patients (HBeAg positive=8, HBeAg negative=19) and both of the treatment groups have been followed 6 months after the treatment. Results There was no difference between groups for age (LAM: 39.8 years: PEG-IFNα:38.2 years, p>0.05). In each two treatment group, the differences among the rates of HBeAg positivity weren't statistically significant. There was no statistically significant difference between two treatment groups for HAI (Hepatic activity İndex) and FIB (Fibrosis) mean values (p>0.05). The levels of HBV DNA before treatment were accepted high if HbeAg positive patients have 105 copy/ml DNA and HbeAg negative patients have 104 copy/ml DNA. All of the patients have carried these criterions. The average ALT levels of the patients before the treatment were 129.0±15.5 and there was no statistically significant difference between two treatment groups for ALT (p>0,05). Conclusion Permanent viral response between LAM and PEG-IFNα treatments are similar. Both of the treatments have been successful when compared to the literature. We did not observe any differences between two treatment modality. We, also, believe that the shortness of the observation time after the treatment and the bad compliance of the patients to the treatment have affected the rate of the success of treatment

Keywords:

Kronik Hepatitis B, peg-IFN, lamivudin,

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