阿德福韦酯挽救治疗拉米夫定耐药患者的临床分析

Rescue treatment of adefovir dipivoxil for lamivudine-resistant CHB patients

目的观察阿德福韦酯挽救治疗拉米夫定治疗后HBV DNA突破患者的疗效。方法将49例拉米夫定治疗后HBV DNA突破的慢性乙型肝炎患者分为3组。A组12例患者直接改用阿德福韦酯治疗,B组25例患者先用拉米夫定与阿德福韦酯联合治疗,HBV DNA阴转后再单用阿德福韦酯治疗,C组12例患者持续应用拉米夫定与阿德福韦酯联合治疗。观察挽救治疗1年血清HBV DNA阴转情况。结果A组10例患者在治疗(3.50±2.07)个月(1～7个月)发生HBV DNA阴转;B组21例患者在治疗(2.05±1.36)个月(1～5个月)发生HBV DNA阴转;C组12例患者在治疗(1.33±0.65)个月(1～3个月)发生HBV DNA阴转。挽救治疗有效的患者维持应答>12个月,治疗期间未发生肾功能损害等明显不良反应。结论拉米夫定治疗后HBV DNA突破患者直接改用阿德福韦酯治疗、先用拉米夫定联合阿德福韦酯再单用阿德福韦酯治疗以及持续拉米夫定联合阿德福韦酯治疗3种方案均是安全有效的。持续拉米夫定联合阿德福韦酯治疗可能是最快和最有效的挽救治疗方案。

Objective To evaluate the efficacy of adefovir dipivoxil（ADV）on chronic hepatitisB（CHB）patients with HBVDNA break- through（〉 1.0× 10^3 copies/ml） after lamivudine （LAM） treatment. Methods Forty-nine CHB patients with HBV DNA breakthrough after LAM trealment were divided into 3 groups. Patients in group A （n=12） were switched to ADV directly. Patients in group B （n=25） were given a combination therapy of ADV and LAM until HBV DNA levels under 1.0×10^3 copies/ml were achieved and then ADV alone. Patients in group C （n=12） received a combination therapy of ADV and LAM constantly. The serum HBV DNA levels were observed over 12 months of rescue treatment. Results HBV DNA levels under 1.0×10^3 copies/ml were achieved in 10 patients in group A after a median treatment duration of （3.50±2.07） months （range 1-7 months）, in 21 patients in group B after a median treatment duration of （2.05±＋1.36） months （range 1-5 months）, and in 12 patients in group C after a median treatment duration of （1.33±0.65） months （range 1-3 months）. Virologic response was maintained more than 12 months in the patients undergoing successful rescue treatment. There were no serious adverse effects such as renal function impairment daring the treatment. Conclusions A switch to ADV treatment, a combination treatment of ADV and LAM and then ADV alone and a constant combination treatment of ADV and LAM are all safe and efficient for CHB patients with HBV DNA break- through after LAM treatment. Moreover, the Constant combination therapy may be the most rapid and efficient rescue strategy to suppress viral replication.