阿德福韦酯初治慢性乙型肝炎患者应答欠佳继续该药治疗的疗效分析

Analysis of therapeutic effect of adefovir dipivoxil in continued treatment of chronic hepatitis B patients with poor early virological response to initial treatment

目的探讨应用阿德福韦酯(ADV)初治慢性乙型肝炎(CHB)患者应答欠佳或失败后继续给予ADV治疗方案的安全性及疗效。方法所有CHB患者均以ADV 10 mg/d作为初始治疗,在治疗12周时,未达到HBV DNA转阴者根据HBV DNA下降值分为三组。三组均继续增加ADV治疗剂量观察。结果 120例初治患者共有94例患者入组。累计转阴率为71/120(59.17%),比较12周时转阴率为26/120(21.67%),χ2=5.837,P<0.05。各组肌酐水平治疗前后无统计学意义。结论 ADV初治病毒学应答欠佳的患者通过延长观察时间至24周及增加每日摄入剂量继续ADV治疗可以提高HBV DNA转阴率,且患者肌酐水平无明显升高。

Objective To explore the safety and therapeutic effect of adefovir dipivoxil in continued treatment of chronic hepatitis B patients with poor early virological response to initial treatment or with failure treatment and to reduce nucleoside medication abuse.Methods All the 120 chronic hepatitis B patients took 10 mg of adefovir dipivoxil as oral dose once a day.The patients without clearance of HBV DNA after 12 weeks treatment with adefovir dipivoxil would be studied and be divided into three groups on the basis of HBV DNA level.They would take adefovir dipivoxil at increased oral dose once a day for another 12 weeks for further observation.Results 94 of 120 patients completed 24 weeks of treatment.The cumulative clearance rate of serum HBV DNA was 71/120（59.17%） in patients with treatment for 24 weeks and 26/120（21.67%） in patients with treatment for 12 weeks,χ2=5.837,P〈0.05.There was no significant difference in serum creatinine level among the groups（P〉0.05）.Conclusion By increasing oral dose of adefovir dipivoxil to 15mg or 20mg once a day and prolonging the treatment time to 24 weeks,the clearance rate of level of serum HBV DNA of patients with poor early virological response in initial treatment can be raised.The significant elevations in serum creatinine level has not been observed and clinical trial sample should be large enough to certify it