阿德福韦酯优化治疗HBeAg阴性慢性乙型肝炎疗效观察

Efficacy of HBeAg-negative chronic hepatitis B with optimization of Adefovir dipivoxil

目的优化阿德福韦酯抗乙肝病毒治疗策略,提高治疗效果。方法将42例HBeAg阴性慢性乙型肝炎患者依照HBV DNA载量分为2组,高病毒载量组22例,拉米夫定联合阿德福韦酯治疗;低病毒载量组20例,阿德福韦酯单药治疗,定期检测HBV DNA、肝功能和乙肝病毒血清标志物(HBV-M)。结果联合治疗组HBV DNA下降速度快,12周有效抑制率为72.7%,显著高于单药治疗组(x^2=23.49,P<0.001);治疗48周后两组患者均获得较高的病毒学应答,HBV DNA有效抑制率(95.45%vs 95%)和测不到率(77.27%vs 80.90%)无统计学差异(P>0.05);治疗12周及48周两组ALT复常率无差异(P>0.05),分别为40%、36.36%,90%、86.36%;两组患者均未出现严重不良反应。结论对于HBV DNA载量较低的初治HBeAg阴性慢性乙型肝炎患者,阿德福韦酯单药治疗可获得较好的疗效,而HBV DNA≥6 log拷贝/mL的高病毒载量患者则需要联合拉米夫定才能获得较高的病毒及生化学应答率。

Objective Optimizing the anti-hepatitis B of virus Adefovir dipivoxil treatment strategies to improve the therapeutic effect. Methods Patients （42） with HBeAg-negative chronic hepatitis B were divided into two groups according to HBV DNA： one with high viral genes group （n=22） which took Lamivudine and Adefovir dipivoxil, the other with low viral genes group （n=20） whieh took Adefovir dipivoxil monotherapy. HBV DNA, liver function test, and HBV serum marker （HBV-M） were detected periodically. Results Serum HBV DNA of taking Lamivudine and Adefovir dipivoxil group declined fast. HBV DNA suppression rate was 72.7% with treatment of 12 weeks, efficacy significantly higher than that in the monotherapy group （ χ^2=23.49, P〈0.001）. There were no significant difference between the two groups of HBV DNA suppression rate （95.45% vs 95%） and HBV DNA undetectable rate （77.27% vs 80.90%） after 48 weeks treatment （P〉0.05）. There were no differences in ALT normalization rate between two groups after the treatment of 12 and 48 weeks （P〉0.05）, they were 40%, 36.36%, 90%, and 86.36%. Two groups of patients did not occur serious drug-related events. Conclusion By initial treatment in lower HBV DNA genes, HbeAg-negative chronic hepatitis B patients with Adefovir dipivoxil monotherapy would get a good effect, but the combination of the Lamivudine and Adefovir dipivoxil was good for patients with HBV DNA≥6 log copies/mL to get a higher rate of viral and biochemical response.