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Efficacy of Lamivudine Therapy for Chronic Hepatitis B in Children
ÀÌÀºÇý, ±è°æ¸ð, ÀåÁÖ¿µ,
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ÀÌÀºÇý ( Lee Eun-Hye )
¿ï»ê´ëÇб³ ÀÇ°ú´ëÇÐ ¼¿ï¾Æ»êº´¿ø ¼Ò¾Æ°úÇб³½Ç
±è°æ¸ð ( Kim Kyung-Mo )
¿ï»ê´ëÇб³ ÀÇ°ú´ëÇÐ ¼¿ï¾Æ»êº´¿ø ¼Ò¾Æ°úÇб³½Ç
ÀåÁÖ¿µ ( Jang Joo-Young )
¿ï»ê´ëÇб³ ÀÇ°ú´ëÇÐ ¼¿ï¾Æ»êº´¿ø ¼Ò¾Æ°úÇб³½Ç
KMID : 0816120080110020130
Abstract
¸ñ Àû: ¼Ò¾Æ ¸¸¼º BÇü °£¿° ȯ¾Æµé¿¡¼ ¶ó¹ÌºÎµò Ä¡·áÀÇ È¿°ú¿Í Áö¼Ó¼º¿¡ ´ëÇØ ¾Ë¾Æº¸°íÀÚ ÇÏ¿´´Ù.
¹æ ¹ý: 1998³â 1¿ùºÎÅÍ 2008³â 5¿ù±îÁö ¼¿ï¾Æ»êº´¿ø ¼Ò¾Æ°ú¿¡¼ ¸¸¼º BÇü °£¿°À¸·Î Áø´Ü¹Þ°í ¶ó¹ÌºÎµò Ä¡·á¸¦ ¹ÞÀº 44¸íÀÇ È¯¾ÆµéÀÇ Àǹ«±â·ÏÀ» ÈÄÇâÀûÀ¸·Î ºÐ¼®ÇÏ¿´´Ù. 12°³¿ù ÀÌ»ó ÃßÀû °üÂûÇß´ø ȯ¾ÆµéÀ» ´ë»óÀ¸·Î ¹ßº´½Ã ¼ºº°, ¿¬·É, Ä¡·á ÀüÈÄÀÇ ALT, Ç÷û HBV- DNA, HBeAg, anti HBe, HBsAg, anti HBsÀÇ º¯È¸¦ Á¶»çÇÏ¿´°í, Ä¡·áÀÇ Áö¼Ó¼º°ú ³»¼º ¹ßÇö¿¡ ´ëÇØ Á¶»çÇÏ¿´´Ù.
°á °ú: ¶ó¹ÌºÎµò Ä¡·á ÈÄ 3³â À̳»¿¡ ÃÑ 44¸íÀÇ È¯¾Æ Áß 21¸í(48%)¿¡¼ Ç÷û ÀüȯÀÌ ÀÌ·ç¾îÁ³°í, 34¸í(77%)¿¡¼ HBV DNA°¡ À½ÀüµÇ¾úÀ¸¸ç, 41¸í(93%)¿¡¼ Ç÷û ALT°¡ Á¤»óȵǾú´Ù. Kaplan-Meier¹ý¿¡ ÀÇÇÑ HBeAg ´©Àû Ç÷û ÀüȯÀ²Àº 3³â°¿¡ 60%·Î ³ªÅ¸³µ´Ù. Ä¡·á¸¦ ¸¶Ä£ ȯ¾Æ 25¸í Áß Ç÷û ÀüȯµÈ 18¸íÀÇ È¯¾Æ ¸ðµÎ ¾à¹° Áß´Ü ÀÌÈÄ ÃÖ´ë 3³â ÃßÀû °üÂû½Ã Àç¹ß ¾øÀÌ Áö³»°í ÀÖ¾î ¶ó¹ÌºÎµò Ä¡·á ¹ÝÀÀÀÇ Áö¼Ó¼ºÀ» º¸¿© ÁÖ¾ú´Ù. Ä¡·á Áß 12¸í(27%)¿¡¼ µ¹ÆÄ Çö»óÀÌ ³ªÅ¸³µ°í, 11¸í(25%)¿¡¼ YMDD µ¹¿¬º¯ÀÌ°¡ ¹ß°ßµÇ¾ú´Ù. Ä¡·á Àü Ç÷û ALT ¼öÄ¡´Â Ç÷û ÀüȯÀ» ÀÌ·é ±º¿¡¼ ´õ ³ô¾ÒÁö¸¸, Åë°èÀû À¯ÀǼºÀº ¾ø¾ú´Ù(338¡¾542 IU/L vs. 144¡¾163 IU/L, p£¾0.05).
°á ·Ð: ¸¸¼º BÇü °£¿° ȯ¾Æ¿¡¼ ¶ó¹ÌºÎµò Ä¡·á½Ã Àý¹Ý Á¤µµ¿¡¼ Ä¡·á È¿°ú¸¦ ±â´ëÇÒ ¼ö ÀÖ¾ú´Ù. ¶ó¹ÌºÎµòÀÇ Ä¡·á ¹ÝÀÀÀº Àå±âÀûÀ¸·Î Áö¼ÓµÇ¾úÀ¸¸ç, ÇâÈÄ ¾àÁ¦ ³»¼º µ¹¿¬º¯ÀÌÀÇ Áõ°¡¿¡ µû¸¥ ÀÌÂ÷ ¾àÁ¦¿¡ ´ëÇÑ Ãß°¡ÀûÀÎ ¿¬±¸°¡ ÇÊ¿äÇÏ´Ù°í »ý°¢µÈ´Ù.
Purpose: Lamivudine is known to be effective for the treatment of chronic hepatitis B in adults. However, data on lamivudine therapy in pediatrics is limited. The aim of this study was to evaluate the efficacy and durability of lamivudine therapy for chronic hepatitis B in Korean children.
Methods: A total of 44 children (27 males and 17 females, ages 6 months to 14.8 years, mean age 6.7 years) with chronic hepatitis B who received lamivudine (3 mg/kg/day, max 100 mg) for at least 12 months were enrolled. We evaluated the serum AST, ALT and serological HBV markers (HBsAg and anti-HBs, HBeAg and anti HBe, and HBV DNA) periodically. Predictive three year cumulative seroconversion rates were obtained using the Kaplan-Meier method.
Results: Twenty one (48%) of 44 children achieved seroconversion of HBeAg by three years, while 23 (42%) children did not. HBV DNA was cleared in 34 (77%) children and the serum ALT levels were normalized in 41 children (93%). The three year cumulative seroconversion rates were 60% for HBeAg, and the clearance rates were 76% for HBV DNA. Eighteen children who discontinued lamivudine after HBeAg seroconversion maintained the therapeutic response for three years (treatment duration 13¡58 months mean 24 months). Viral breakthrough developed in 12 children (27%) during the therapy and the YMDD mutation was documented in 11 children (25%). The mean duration for the development of a mutation was 22.7 months. Loss of HBsAg occurred in 6 children (14%). The pretreatment ALT levels were higher in responders; however, the differences were not statistically significant (p£¾0.05).
Conclusion: The results of this study showed that lamivudine treatment had a favorable effect and durable therapeutic response in children with chronic hepatitis B. Long term follow-up and alternative therapy are warranted for those patients who do not respond to this treatment.
Å°¿öµå
Chronic hepatitis B;Lamivudine;Seroconversion;Resistance;YMDD mutation
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