阿德福韦酯长期单用或联合拉米呋定治疗拉米呋定耐药慢性乙型肝炎临床研究

Efficacy of Long-term Adefovir Dipivoxil Monotherapy or Combination with Lamivudine in Treatment of Lamivudine-resistant Chronic Hepatitis B

目的 评估阿德福韦酯（ADV）长期单用或联合拉米呋定（LAM）治疗拉米呋定耐药慢性乙型肝炎疗效.方法 拉米呋定耐药慢性乙型肝炎患者75例分为两组,A组：32例患者接受联合治疗,B组：43例患者,单用阿德福韦酯治疗,连续18个月.结果 A组HBV DNA 检测不到率在3,6,12,18个月时分别28.1%,43.8%,71.9%,87.5%,B组分别为27.9%,37.2%,60.4%,67.4%,两组比较在18个月差异有统计学意义（χ2=4.05,P〈0.05）;两组ALT复常率比较在A组明显高于B组,但仅在18月差异有统计学意义（χ2=4.76,P〈0.05）;B组阿德福韦酯耐药5例,而A组无阿德福韦酯耐药发生（P〈0.05）.结论 阿德福韦酯单用或联合联合拉米呋定对拉米呋定耐药慢性乙型肝炎均有效,联合用药效果更好,其优势随治疗时间延长更显著.

Objective To assess the efficacy of long-term adefovir treatment alone or combination with lamivudine in treatment of Lamivudine-resistant chronic hepatitis B. Methods Seventy-five patients with lamivudine-resistant chronic hepatitis B were divided into two groups ：A and B. Thirty-two patients received combination therapy ,while the other forty-three patients were subjected to adefovir alone treat- ment. Results At the end of the 3,6,12 and 18 months of treatment, the negative rate of HBV DNA dedection were 28.1% ,43.8 % ,71.9 % and 87.5%, respectively, in patients of group A ,27.9% ,37.2% ,60.4% and 67.4%, respectively, in patients of group B. The negative rate of HBV-DNA dedection in patients of group A was significantly higher than that in patients of group B （X2 = 4. 05, P 〈 0.05 ） only after 18months. At the end of 18 months of treatment,the rate of ALT normalization in patients of group A was significantly higher than that in patients of group B （X2 = 4. 76, P 〈 0.05 ）. Adefovir Dipivoxil-resistant in patients of group A was four, and zero in group B （ P 〈0. 05 ） Conlusion ADV monotherapy or in combination with lamivudine is effective in the treatment of lamivudine-resistant positive CHB. The overall efficacy of combination therapy is better than that of monothrapy.