7例阿德福韦酯停药发生慢加急性肝衰竭的临床分析

Clinical analysis on 7 cases of liver failure after adefovir dipivoxil withdrawal

目的研究阿德福韦酯停药发生慢加急性肝衰竭的临床特点。方法对7例停用阿德福韦酯并在1年内发生慢加急性肝衰竭患者的临床资料进行分析。结果7例患者均每日口服阿德福韦酯10mg，疗程28～120（平均61．7）wk。治疗后6例HBV-DNA低于检测限（3log10copies／mL），1例获得病毒学应答后出现病毒反弹，6例获得生化学应答，2例发生血清学转换。2例患者认为病情稳定可暂停治疗而自行停药，4例由于经济困难而停药，1例因药物疗效不佳而停药。复发时间为停药后7-20wk，平均12．4wk。7例患者中4例复发后改用恩替卡韦抗病毒，2例继续使用阿德福韦酯，1例使用阿德福韦酯及拉米夫定联合抗病毒。治疗后4例好转，3例因肝功能衰竭死亡。结论慢性乙型肝炎应用阿德福韦酯治疗停药后易复发，治疗前肝功损害严重者，复发后易出现肝衰竭，复发后应尽早应用核苷（酸）类药物挽救治疗。

Objective To investigate the clinical characteristics of cases of acute hepatic failure after adefovir dipivoxil withdrawal. Methods 7 cases of acute hepatic failure after adefovir dipivoxil withdrawal were investigated and followed up. The course of disease and diagnoses, the dosage of adefovir dipivoxil, the course of treatment, the curative effective and causes of withdrawing drugs were recorded. The liver function, the changes of serumology and virusology, re-therapy and prognosis were observed. Results The dose of adefovir dipivoxil is 10 mg once daily. Patients were treated for 28-120 weeks （average： 1.7 weeks）. 6 cases got HBV-DNA undetectable （31ogl0copies/ml）. 1 case got HBV DNA break though during anti-virus therapy. 2 cases got seroconversion. 2 cases discontinued therapy by own, 4 cases discontinued because economic reason, 1 case discontinued for poor efficacy. The recurrent period is 12.4 weeks on average. 2 cases took adefovir dipivoxil again, 3 cases changed to entecavir, 1 case changed to adefovir dipivoxil and lamivudine combination therapy. 4 cases recovered after re-therapy, 3 cases died because of liver failure. Conclusions It is easy for patients with chronic hepatitis B to recur after withdrawing adefovir dipivoxil. Those whose liver function was seriously damaged before treatment tend to have liver function decompensation after recurrence. Nucleoside analogue should be taken soon after recurrence.