摘要
目的探讨替比夫定治疗慢性乙型肝炎出现病毒变异后的治疗方案。方法将66例患者随机分为3组,A组单用阿德福韦酯治疗48周;B组采用阿德福韦酯与替比夫定联合治疗12周,后单用阿德福韦酯治疗36周;C组采用阿德福韦酯与替比夫定联合治疗48周。结果①A、B、C 3组治疗12周内ALT水平反弹升高的患者比例分别为27%(6/22),14%(3/22),5%(1/22)(P<0.05);治疗12周、24周3组rtM204 I变异株检测阳性率分别为18%(4/22),5%(1/22),0和5%(1/22),0,0,48周变异株检测阳性率均为0。②治疗48周3组间ALT水平、e抗原阳性患者血清转换率比较均无显著性差异(P均>0.05),C组ALT复常率、HBV DNA转阴率与A组比较有显著性差异(P<0.05),3组的HBV DNA转阴率分别为64%(14/22),77%(17/22),100%(22/22),A组rtN236T、rtA181V+rtN236T变异各1例,B组rtN236T变异1例。结论替比夫定治疗慢性乙型肝炎出现rtM204 I变异后采用与阿德福韦酯联合治疗更安全有效。
Objective It is to approach the therapeutic program of chronic hepatitis B virus variants after telbivudine treatment.MethodsSixty-six patients were randomly divided into three groups： group A of single-use adefovir dipivoxil for 48 weeks;group B with adefovir dipivoxil and telbivudine combination therapy for 12 weeks and a single treatment with adefovir dipivoxil for 36 weeks;group C were treated with adefovir dipivoxil and telbivudine for48 weeks.Results①The rebound rates of elevated ALTlevels in group A,B and C for 12 weeks were 29%（7/22）,14%（3/22）,5%（1/22） respectively（P0.05）;after 12 weeks,and 24 weeks for treatment,rtM204I mutant positive rate in these groups were 18%（4/22）,5%（1/22）,0 and 5%（1/22）,0,0 respectively,but it was 0 after 48 weeks in all groups.②For 48 weeks of treatment,theALT levels and e antigen seroconversion rates in patients showed no significant difference among the 3 groups（allP0.05）.Compared with group A,ALTnormalization and HBV DNA negative rate in group C was significantly improved（P0.05）.HBV DNA negative conversion rates in 3 groups were 64%（14/22）,77%（17/22） and 100%（22/22） respectively.One case with rtN236T and one case with rtA181V ＋rtN236Tmutation in group A;one case with rtN236Tmutation in Group B.Conclusion It is more safe and effective for the combination therapy with adefovir dipivoxil on Telbivudine treatment of chronic hepatitis B after emergence rtM204I variation.
出处
《现代中西医结合杂志》
CAS
2011年第30期3791-3793,共3页
Modern Journal of Integrated Traditional Chinese and Western Medicine
