阿德福韦酯联合拉米夫定治疗耐拉米夫定乙型肝炎的疗效观察

The therapeutic effect of adefovir dipivoxil in combination with lamivudinin in treating patients with Hepatitis B resistant to lamivudin

目的探讨阿德福韦酯联合拉米夫定治疗耐拉米夫定乙型肝炎的价值。方法 79例耐拉米夫定的乙型肝炎患者随机分为观察组(39例)和对照组(40例),观察组给予阿德福韦酯(ADV)+拉米夫定(LAM),对照组给予阿德福韦酯治疗,比较3个月、6个月、12个月时血清ALT复常率,HBV-DNA、HBeAg阴转率及血清转换率的差异。结果疗程12个月时,HBeAg阴转率、HBeAg/抗-HBe转换率观察组高于对照组,分别为40.6%vs13.9%,40.6%vs11.1%(P<0.05);疗程12个月时,ALT复常率观察组为82.1%,明显高于对照组的60.0%(P<0.05);HBV-DNA阴转率在治疗6个月、12个月时观察组显著高于对照组,分别为71.8%vs27.5%,76.9%vs47.5%(P<0.01)。结论阿德福韦酯联合拉米夫定治疗耐拉米夫定乙型肝炎的疗效明显优于单用阿德福韦酯,其可作为耐拉米夫定乙型肝炎治疗首选方法。

Objective To investigate the value of Adefovir dipivoxil（ADV）in combination with lamivudinin（LAM）in treating patients with Hepatitis B resistant to the treatment of LAM.Methods Seventy-nine patients with Hepatitis B resistant to the treatment of LAM were divided into observing group（39 cases）and control group（40 cases）,which were treated with ADV＋LAM,and ADV,respectively.The difference in serum ALT normali-zation rate,HBV-DNA negative rate,HBeAg negative rate and HBeAg/Anti-HBe transition rate between two groups were observed.Results At 12 months of treatment,Serum HBeAg negative rate and HBeAg/Anti-HBe transition rate in observing group were higher than those in control group（40.6% vs 13.9% and 40.6% vs 11.1%,P〈0.05）,and ALT normalization rate（82.1%）in observing group was also higher than that（60.0%） of control group（P〈0.05）.HBVDNA negative rate in observing group at 6 months and 12 months of treatment were markedly higher than those in control group（71.8% vs 27.5% and 76.9% vs 47.5% P〈0.01）.Conclusions The therapeutic effect of ADV in combination with LAM is markedly superior to that of ADV alone in treating patients with Hepatitis B resistant to LAM,ADV and LAM combination therapy may be the first-choice for patients with LAM resistance.