拉米夫定联合阿德福韦酯治疗阿德福韦酯停药后出现的病毒学反弹

Effective Treatment for Patients with Viral Relapse after Adefovir Withdrawl by the Combination of Lamivudine plus Adefovir

目的比较拉米夫定+阿德福韦酯联合治疗与阿德福韦酯单药治疗对阿德福韦酯停药后出现病毒学反弹而无基因型耐药变异患者的疗效及安全性。方法回顾研究2007年1月-2012年1月在传染科门诊就诊的67例阿德福韦酯治疗获得病毒学应答但停药后出现病毒学反弹的e抗原阳性慢性乙型肝炎患者,分别给予拉米夫定+阿德福韦酯联合治疗(联合组,n=35)和阿德福韦酯单药治疗(单药组,n=32)。结果治疗1年后,联合组(32例,85.7%)较单药组(21例,65.6%)有更多的患者重新获得了丙氨酸转氨酶复常(P=0.009),联合组34例(97.1%)乙型肝炎病毒DNA阴转,单药组22例(68.8%)阴转,两组差异有统计学意义(P=0.002);在血清学转换方面,联合组和单药组分别有4例(11.4%)和1例(3.1%)患者获得了e抗原的血清学转换。在治疗中所有患者均未发生任何严重不良反应。结论阿德福韦酯停药后出现病毒学反弹,选择拉米夫定与阿德福韦酯联合治疗可使患者重新获得较好的生化学和病毒学应答。

Objective To seek reasonable treatment plans for chronic hepatitis B（CHB） patients who had viral relapse after cessation of adefovir（ADV）,and to compare the efficacy and safety between a combined therapy of lamivudine（LAM） plus ADV and ADV alone for the retreatment of patients with viral relapse after cessation of ADV but without genotypic drug-resistance mutations.Methods Between January 2007 and January 2012,we retrospectively analyzed the clinical data of 67 hepatitis B e antigen（HBeAg）-positive patients who had virological response to ADV and viral relapse after cessation of ADV.They received either LAM plus ADV（n=35） or ADV alone（n=32） treatment.Results After one-year treatment,more patients who received LAM plus ADV than those who received ADV alone had alanine aminotransferase（ALT） normalization [32/35（85.7%）,21/32（65.6%）;P=0.009] and HBV-DNA negativity [34/35（97.1%）,22/32（68.8%）;P=0.002].In respect of serological response,4 patients（11.4%） receiving LAM plus ADV and 1 patient（3.1%） receiving ADV alone had HBeAg seroconversion respectively.During the period of retreatment,no serious side effects were reported.Conclusion Combination of LAM plus ADV can allow patients to regain good biochemical and virological response for CHB patients with viral relapse after cessation of ADV.