阿德福韦酯治疗HBV野生株与变异株混合感染患者3月疗效观察

Three month-efficacy of adefovir dipivoxil in the treatment of patients with lamivudine-related hepatitis B viral YIDD or YVDD mutant infection

目的观察拉米夫定治疗耐药的HBV变异株感染及变异株和野生株混合感染患者在加用阿德福韦酯治疗后的近期疗效。方法在30例拉米夫定治疗耐药的慢性乙型肝炎患者,经荧光定量PCR法检测发现HBV YIDD或YVDD变异株感染者21例,变异株与野生株混合感染者9例。给予他们阿德福韦酯联合拉米夫定治疗3月,观察近期疗效。结果在21例变异株感染患者,治疗前血清HBV DNA水平为6.2±1.4 lgcopies/ml,治疗后降为2.3±2.3lgcopies/ml。ALT水平为138.8±153.2U/L,治疗后降为54.5±44.7U/L。AST水平为119.0±175.6U/L,治疗后降为39.8±32.1U/L;在9例混合性感染患者,HBV DNA基线水平为6.0±1.9 lgcopies/ml,治疗后降为2.4±2.4 lgcopies/ml。ALT基线水平为144.7±128.2 U/L,治疗后降为55.8±53.2 U/L。AST基线水平为114.2±131.1 U/L,治疗后降为42.8±32.3U/L,两组各指标相比,均无统计学差异(P>0.05);在21例变异株感染患者中,治疗后19例(90.5%)HBVDNA转阴,19例(90.5%)ALT复常,在9例混合性感染组,治疗后8例(88.9%)HBV DNA转阴,7例(77.8%)ALT复常(P>0.05)。在变异株感染患者,未发生HBeAg血清转换,而在混合性感染组有37.5%(3/8)发生HBeAg血清转换。结论阿德福韦酯联合拉米夫定治疗变异株感染或野生株与变异株混合感染患者,近期疗效相似。

Objective To observe the 3 month-efficacy of adefovir dipivoxil in the treatment of patients with lamivudine-related hepatitis B viral YIDD or YVDD mutant infection.Methods 30 lamivudine-resistant chronic hepatitis B patients were treated by combination of adefovir dipivoxil and lamivudine in this study for three months.The serum HBV DNA was detected by fluorescent quantitation PCR.Results The HBV YIDD or YVDD mutant infection was found in 21 patients,and the mixed mutant and wild viral infection was found in 9;the baseline of serum HBV DNA,ALT and AST in mutant group were 6.2±1.4 lgcopies/ml,139.8±153.2U/L and 119.0±32.1U/L,respectively.After 3 month treatment,they dropped to 2.3±2.3lgcopies/ml,54.5±44.7U/L and 39.8±32.1U/L,respectively;the baseline of them in mixed infection group were 6.0±1.9 lgcopies/ml,144.7±128.2U/L and 114.2±131.1U/L,respectively and after 3 month treatment,they dropped to 2.4±2.4lgcopies/ml,55.8±53.2U/L and 42.8±32.3U/L,respectively（P〉0.05）;the HBV DNA loss in mutant infection was found in 90.5%,serum ALT normalization in 90.5%,and the HBV DNA loss and ALT normalization in mixed infection were 88.9% and 77.8%,respectively;no HBeAg seroconversion was found in mutant infection group,while 37.5%（3/8）had HBeAg seroconversion in mixed infection group.Conclusion Conbination of lamivudine and adefovir dipivoxil therapy for patients with hepatitis B mutant or mutants and wild viral infection can get the same short-term efficacy.