数学模型等会比较复杂，直接的结论也会有偏差。 但我们关注的是闪耀着光芒的思想，呵呵。这样的思想很冲击力，因而很有启发。 04年有个研究，当时的结果证明了拉米+干扰并不比单用其一更有效。 但现在已经有了不同的声音。印度的一项研究（如下）支持了楼主的主要思路。 Superior Results Using Antiviral Agents Before Pegylated Interferon to Treat Hepatitis B Several nucleoside/nucleotide analog antiviral agents are active against hepatitis B virus (HBV), including lamivudine (Epivir-HBV), adefovir (Hepsera), entecavir (Baraclude), telbivudine (Tyzeka), and tenofovir (Viread; not yet approved for this indication). The immunomodulators interferon alfa-2b and pegylated interferon alfa-2a are also approved therapies for chronic hepatitis B. Studies have shown that lower pre-treatment HBV viral load is associated with better treatment response. As reported in the January 2007 American Journal of Gastroenterology, researchers from India conducted a study to assess whether use of lamivudine to lower HBV DNA levels before adding an immunomodulator is more effective than using an immunomodulator from the outset.
The study included 63 treatment-naive HBeAg-positive chronic hepatitis B patients with alanine aminotransferase (ALT) levels > 1.2 x the upper limit of normal. Participants received either 100 mg/day lamivudine (n = 36) or placebo (n = 27) for 4 weeks, followed by 1.0 mcg/kg/week pegylated interferon for 24 additional weeks. Patients were followed for 24 weeks after completion of therapy, and biochemical and virological responses were assessed at weeks 4, 28, and 52 using an intention-to-treat analysis.
Results • At week 4, the mean log changes in HBV DNA from baseline were 1.2186 in the lamivudine group and 0.2594 in the placebo group (P = 0.032).
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At week 28, 16 patients (44.4%) in the lamivudine group and 8 (29.6%) in the placebo group had undetectable HBV DNA (P = 0.298).
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At week 28, HBeAg loss occurred in 15 subjects (41.7%) in the lamivudine group and 8 (29.6%) in the placebo group (P = 0.43).
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6 months after treatment (week 52), 18 patients (50%) who received lamivudine and 4 (14.8%) who received placebo had sustained undetectable HBV DNA (P = 0.028).
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HBeAg loss was maintained in 14 (38.9%) and 4 (14.8%) patients, respectively (P = 0.05).
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In terms of biochemical response, 10 patients (27.8%) in the lamivudine arm and 5 (18.5%) in the placebo group had normalized ALT at week 28 (P = 0.552).
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At week 52, the respective normal ALT figures were 13 (36.1%) and 5 (18.5%) (P = 0.159).
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There was a significant correlation among HBeAg loss, appearance of anti-HBe antibodies, and undetectable HBV DNA levels at week 28 (P = 0.008) and week 52 (P < 0.001) and HBV DNA levels at week 4. ------------------ 望楼主继续，不能半途而废。呵呵。
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楼主: baobao7676
发表于 2007-5-8 11:25
