拉米夫定治疗慢性乙型肝炎患者出现耐药的后续治疗观察

Subsequent anti-viral therapy in patients with chronic hepatitis B following resistance to initial lamivudine treatment

目的:探讨慢性乙型肝炎患者在拉米夫定治疗耐药后,采用联合阿德福韦酯和单用恩替卡韦的后续抗病毒治疗的疗效。方法:49例拉米夫定初治耐药患者分为2组,A组40例接受联合治疗,拉米夫定100 mg.d-1,阿德福韦酯10 mg.d-1;B组9例单用恩替卡韦,1.0 mg.d-1,每3月进行血清肝功能和病毒学指标检测,前后共随访15月。结果:2组的ALT复常率在15个月时基本相同,A组的HBV DNA阴转率和HBeAg/抗-HBe转换率显著高于B组(P<0.05),A组HBV DNA阴转率在治疗第15个月时达到100%,HBeAg/抗-HBe转换率在治疗第15个月时达到25%。结论:拉米夫定联合阿德福韦酯治疗对拉米夫定耐药的慢性乙肝患者疗效较好。

Objective： To evaluate the efficacy of entecavir alone or lamivudine combined with adefovir in the treatment of patients with chronic hepatitis B following lamivudine resistance.Methods： Forty-nine patients with lamivudine resistance were enrolled.Patients received anti-viral therapy of lamivudine 100 mg·d-1 combined with adefovir 10 mg·d-1（n=40） or entecavir alone（n=9）.Liver function and serum virology were evaluated every three months in all patients.The follom-up times were fifteen months.Results： Normalization rate of liver function in the two groups were similar.HBV DNA clearance rate and HBeAg/anti-HBe seroconversion rate were significantly higher in combination group than in entecavir alone group（P0.05）.HBV DNA clearance rate reached 100% and HBeAg/anti-HBe seroconversion rate 25% at 15th months after combined treatment.Conclusion： Combination of lamivudine with adefovir has advantage over entecavir alone as a subsequent antiviral therapy in the treatment of chronic hepatitis B following lamivudine resistance.