拉米夫定联合阿德福韦酯治疗拉米夫定耐药HBeAg阳性慢性乙型肝炎患者的疗效观察

Effect of adefovir dipivoxil combined with lamivudine in treantment of chronic hepatits B patients with HBeAg positive after lamivudine resistance

目的探讨拉米夫定(LAM)联合阿德福韦酯(ADV)治疗拉米夫定耐药的HBeAg阳性慢性乙型肝炎患者的临床治疗价值。方法将LAM耐药的HBeAg阳性慢性乙型肝炎患者分为A、B两组,A组(123例)继续口服LAM每日100mg,同时加用ADV每日10mg;B组(108例)停用LAM,仅口服ADV每日10mg治疗。疗程均为48周。采用实时荧光定量PCR进行HBV DNA载量检测,酶联免疫吸附试验进行乙型肝炎病毒表面标志物检测,同时检测ALT、AST。结果 A组治疗48周,ALT复常率、HBV DNA低于检测下限的比率、HBeAg低于检测下限的比率及抗-HBe血清转换率分别为88.6%、80.5%、35.8%、16.7%。B组治疗48周,ALT复常率、HBV DNA低于检测下限的比率、HBeAg低于检测下限的比率及抗-HBe血清转换率分别为77.8%、63.9%、16.7%和13.0%。A组明显高于B组,差异有统计学意义(P<0.05)。结论 LAM联合ADV治疗LAM耐药HBeAg阳性慢性乙型肝炎患者的临床治疗效果优于单用ADV治疗。

Objective To investigate the value of adefovir dipivoxil combined with lamivudine treatment after lamivudine resistance in chronic hepatitis B patients with HBeAg positive.Methods Patients were divided into two groups.Group A were treated with lamivudine associated with adefovir dipivoxil after lamivudine resistance.Group B were treated with adefovir dipivoxil instead of lamivudine.HBV DNA was detected by real-time PCR,and HBV markers were detected by ELISA.ALT and AST were also detected.Results After 48 weeks treatment,the normalization rate of ALT in group A was 88.6%,the rate of HBV DNA undetectable was 80.5%,the rate of HBeAg undetectable was 35.8%,and anti-HBe serum conversion rate was 16.7%.Meanwhile,the normalization rate of ALT in group B was 77.8%,the rate of HBV DNA undetectable was 63.9%,the rate of HBeAg undetectable was 16.7%,and anti-HBe serum conversion rate was 13.0%.All indexes in group A were obviously higher than those in group B,with statistical difference.Conclusions Effect of lamivudine associated with adefovir dipivoxil in treatment of chronic hepatitis B patients after lamivudine resistance is better than swiching to adefovir dipivoxil.