Predictive Analysis Of Curative Effect Of Chinese Medicine Combined With Adefovir Dipivoxil In The Treatment Of Chronic Hepatitis B

Objective:To analyze the factors influencing the 48th week's curative effect of the treatment which is chinese medicine combined with adefovir dipivoxil.To screen out the predictive factors which associated with 48th week curative effect.To evaluate the predictive value of this factors aimed at providing evidence for the efficacy prediction of the clinical treatment.Methods:560 cases were brought into the research which from the national key project of the 11th-5 years plan named "the research of Chinese Medicine syndrome in CHB and the integrated medicine(the part whose ALT?2xULN)" to do restropective study.1.To analyze the influence of the ALT,HBV DNA and HBeAg at baseline,12th week and 24th week to the outcomes,including HBeAg losing,HBeAg seroconversion,HBV DNA undetectable,and complete response at time point of the 48th week within total FAS,experimental group(treated with chinese medicine combined with adefovir dipivoxil)and control group(treated with adefovir dipivoxil alone)by Chi-squared test.2.Compare the characteristics of the people with HBeAg lost and those with HBeAg not lost at each time points by Chi-squared test.Using the method of rank-sum test to analyze the characteristics of HBeAg and ALT between the people with HBeAg lost,those with HBeAg not lost and the experimental group,the control group at each time points.3.Using the method of multiple factors analysis of Logistic regression,to analyze the affection of the factors,such as traditional Chinese medicine intervention or not,whether mother-to-child transmission,gender,age,baseline level of ALT,HBeAg and HBV DNA,relevant indicators of the 12th week and 24th week,the descend range of HBeAg from baseline to 12th or 24th week to the outcomes,including HBeAg losing,HBeAg seroconversion,HBV DNA undetectable and complete response at time point of the 48th week.And to screen out the factors influencing the curative effect.4.Using the method of receiver operating characteristic curve to to evaluate the predictive value of the factors selected by Logistic regression,and to find out good prediction model.Results:1.The people with a higher ALT,a lower HBeAg,HBV DNA level at baseline and 12th or 24 week ALT return to normal level,HBV DNA undetectable,HBeAg losing will get a better curative effect.2.whether the total FAS,the experimental group and the control group,the rate of the HBeAg losing and the HBeAg seroconversion from 12-24week was increasing.About the 12th,24th,36th week ALT level and 12th week HBeAg level between the experimental group and the control group the difference was statistically significant.Between the people with HBeAg lost and those with HBeAg not lost at 48th week the ALT and HBeAg level,the difference was statistically significant.3.Independent factors affecting HBeAg losing are traditional Chinese medicine intervention,people who got CHB not by the mother-to-child transmission,low level of baseline HBeAg,12th week ALT return to normal level,the 24th week HBV DNA undetectable,the great descend range of HBeAg from baseline to 12th or 24th week;Independent factors affecting HBeAg seroconversion are traditional Chinese medicine intervention,people who got CHB not by the mother-to-child transmissionand low level of baseline HBeAg,12th week ALT return to normal level,the 24 week HBV DNA undetectable,the great descend range of HBeAg from baseline to 12th or 24th week;Independent factors affecting HBV DNA undetectable are high level of baseline ALT,low level of baseline HBeAg and HBV DNA,12th or 24th week ALT return to normal level,the great descend range of HBeAg from baseline to 12th or 24th week;Independent factors affecting complete response are younger in age and low level of baseline HBeAg,24th week ALT return to normal level and HBV DNA undetectable,the great descend range of HBeAg from baseline to 12th or 24th week.4.The traditional Chinese medicine intervention,level of baseline HBeAg,12th week ALT,the 24th week HBV DNA,the descend range of HBeAg from baseline to 12th week have predictive value to the HBeAg losing at 48th week.Level of baseline HBeAg,12th week ALT,the 24th week HBV DNA,the descend range of HBeAg from baseline to 12th week have predictive value to the HBeAg seroconversionat 48th week.Level of ALT,HBeAg,HBV DNA at baseline,12th or 24th week ALT,the descend range of HBeAg from baseline to 12th or 24th week have predictive value to HBV DNA undetectable at 48th week.Age,level of baseline HBeAg,the descend range of HBeAg from baseline to 12th week,the 24th week HBV DNA,the 24th week ALT have predictive value to complete response.Conclusions:1.Whether total FAS,the experimental group and the control group,which have a higher ALT level,lower HBeAg?HBV DNA level at baseline will be a good predictive factor to the 48th week HBeAg losing and HBV DNA undetectable.2.Both the experimental group and the control group which 12th or 24th week ALT return to normal level,HBeAg losing and HBV DNA undetectable will get a better curative effect at the end of treatment.3.The people which reach HBeAg losing on the early stage of treatment will have a high rate of HBeAg losing at 48th week in trend.And the traditional Chinese medicine intervention group higher than treated with adefovir dipivoxil in trend.4.The curative effect of traditional Chinese medicine intervention is superior to treated with adefovir dipivoxil alone at 48th week HBeAg losing.5.The traditional Chinese medicine intervention can improving the rate of HBeAg losing at 48th week.Besides,mother-to-child transmission,age,baseline level of ALT,HBeAg and HBV DNA,relevant indicators of the 12th or 24th week,the descend range of HBeAg from baseline to 12th or 24th week are the important predictive factors.And the 12th or 24th week HBeAg is the best predictive factor in all.6.The predictive value of 24th week relevant indicators is higher than 12th week.The function of traditional Chinese medicine intervention is significant.The predictive value of model which is combination of multiple factors is higher than single factor.7.The people age<30.5(for people aged 18?65 in this study),baseline level of HBeAg<547.950 S/CO,the descend range of HBeAg from baseline to 12th week>0.31 at 12th week have more possibility to reach complete response at 48th week.8.The people age<30.5(for people aged 18?65 in this study),baseline level of HBeAg<547.950 S/CO,24th week ALK51.2IU/L,24th week HBV DNA<3.71og10IU/ml at 24th week have more possibility to reach complete response at 48th week.