阿德福韦酯治疗拉米夫定耐药慢性乙型肝炎的疗效观察

Efficacy of adefovir dipivoxil in treating patients with hepatitis B resistant to lamivudine

目的:探讨阿德福韦酯治疗拉米夫定耐药慢性乙型肝炎的疗效及安全性。方法:选择68例拉米夫定耐药的慢性乙型肝炎患者予以阿德福韦酯10mg/d,疗程1年以上。于治疗前和治疗12、24、52周检测肝肾功能、HBVDNA定量、HBeAg、抗HBe,观察药物不良反应。结果:治疗12、24、52周时,HBVDNA定量较用药前平均分别下降1.6lg拷贝/mL(t=10.10,P<0.01)、2.9lg拷贝/mL(t=13.01,P<0.01)、4.5lg拷贝/mL(t=14.08,P<0.01);HBVDNA转阴率分别是4.41%、19.12%和54.41%;ALT复常率分别为19.12%、48.53%和70.59%;HBeAg阴转率分别为0%、19.44%和47.22%。常见不良反应有轻微乏力、右上腹不适、腹胀,有2例患者发生腹泻,1例血清肌酐轻微改变。结论:阿德福韦酯治疗拉米夫定耐药慢性乙型肝炎的疗效肯定,安全性好。

AIM： To evaluate the efficacy and safety of adefovir dipivoxil in treating patients with hepatitis B resistant to lamivudine. METHODS： 68 patients with hepatitis B resistant to lamivudine were administered 10 mg adefovir dipivoxil orally daily for over 1 years. The serum HBV-DNA levels were measured by quantitative PCR and liver function test, HBeAg/anti-HBe and safety assessments were also performed at 0,12,24,52 weeks after treatment. RESULTS： After 12,24, 52 weeks of treatment, the mean HBV-DNA levels were reduced by 1.6 lg copies/mL （ t = 10.10, P 〈 0.01）, 2.9 lg copies/mL （ t= 13.01, P 〈 0.01） and 4.5 lg eopies/mL（ t = 14.08, P 〈 0.01 ）. The normalization rates of ALT levels were 19.12% ,48.53% and 70.59%. The HBeAg loss rates were 0%, 19.44% and 47.22%. The HBV-DNA undetectable rates were 4.41%, 19.12% and 54.41% respectively. CONCLUSION： Adefovir dipivoxil is effective and safe for treating chronic hepatitis B patients with lamivudine resistance.