阿德福韦酯对拉米夫定耐药的慢性乙型肝炎患者的疗效观察

The Effect of combined Adefovir dipivoxil and Lamivudine therapy on Lamivudine resistant Hepatitis B virus infection

目的观察阿德福韦酯(ADV)治疗拉米夫定(LAM)耐药的慢性乙型肝炎的疗效及ADV的耐药情况。方法152例拉米夫定耐药(也称YMDD变异)的慢性乙型肝炎患者分为治疗1组和治疗2组各76例。治疗1组停用LAM,单用ADV10mg/d口服。治疗2组继续服用LAM100mg/d,加用ADV10mg/d联合服用。通过测定HBVDNA、ALT、HBeAg水平,比较治疗12周、24周、48周、96周时的HBVDNA转阴(应答)率、ALT复常率及HBeAg阴转率。结果治疗12周时2组的HBVDNA阴转率、ALT复常均明显高于1组(P<0.05)。24周时、48周时两组大部分HBVDNA能阴转,ALT能复常;两组无统计学差别(P>0.05);96周时1组有12例出现HBVDNA又转阳性,ALT异常,即出现了ADV耐药。2组疗效稳定,没出现ADV耐药。96周时两组HBeAg阴转率无统计学意义(P>0.05)。结论ADV与LAM联合治疗LAM耐药的慢性乙型肝炎比单用ADV治疗能更早显效,且能降低ADV耐药的发生。

Objective To evaluate the therapeutic efficacy of combined Adefovir dipivoxil and Lamivudine therapy on Lamivudine resistant Hepatitis B virus （HBV） infection.Methods A total of 152 Lamivudine resistant chronic hepatitis B patients were randomly allocated to Adefovir dipivoxil treatment （n=76）and combined Adefovir with Lamivudine treatment group （n=76）.Both groups were given the routine dose for 96 weeks.Serum HBV DNA level was measured by quantitative PCR at 12,24,48 and 96 weeks.The levels of ALT and HBeAg were also measured.Results At 12 th week of treatment,HBV DNA and ALT levels were decreased significantly in the combined treatment group than the Adefovir group.At week 24 and 48,there was no difference in HBV DNA negative and normal ALT patients in both groups.At 96 th week of treatment,HBV DNA and ALT were recurrent in Adefovir group.Furthermore,there was no sig41nificant difference in HBeAg negative conversion in both groups.Conclusion Lamivudine combined with Adefovir dipivoxil results in a low resistant rate and is more effective than Adefovir alone.