阿德福韦酯在拉米夫定耐药慢性乙肝治疗中的应用

Application of adefovir dipivoxil in lamivudine-resistant chronic hepatitis B(CHB)

目的:探讨单用阿德福韦酯与阿德福韦酯联合拉米夫定对拉米夫定耐药性慢性乙型肝炎患者的临床效果。方法:104例拉米夫定耐药行慢性乙型肝炎患者随机分为观察组(n=52)与对照组(n=52),对照组仅给予阿德福韦酯治疗,观察组在对照组基础上联合应用拉米夫定治疗,对比两组治疗效果。结果:经治疗两组血谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBil)、HBV-DNA均明显降低,差异具有统计学意义(P<0.05);且治疗后观察组ALT、AST、HBV-DNA低于对照组,差异具有统计学意义(P<0.01);治疗后观察组HBV-DNA及乙肝病毒e抗原(HBeAg)转阴率均明显高于对照组,差异具有统计学意义(P<0.05);两组治疗过程中均未出现明显严重不良反应及副作用。结论:阿德福韦酯联合拉米夫定在拉米夫定耐药的慢性乙型肝炎患者中可起到协同治疗作用,疗效确切,安全可靠,但在用药期间应注意肾功能的变化。

Objective： To discuss the clinical effects of adefovir dipivoxil alone or adefovir dipivoxil combining with lami vudine in patients with lamivudine-resistant CHB. Methods： 104 patients with lamivudine-resistant CHB were randomly divided into the observation group （n= 52） and the control group（n = 52）, the observation group were treated with adefovir dipivoxil combining with lamivudine, and the control group were treated with adefovir dipivoxil alone, and then the clinical effects were contrasted between the two groups. Results： ALT, AST, TBil, and HBV DNA were significantly reduced in the both groups after the treatment （P〈0.05）, and ALT, AST, and HBV DNA in the observation group were significantly lower than the control group （P〈0.01） ; there was no significantly difference in TBil between the two groups （P〉0.05） ; the negative rates of HBV-DNA and HBeAg in the observation group were significantly higher than that in the control group （P〈0.05）. Conclusion.. Adefovir dipivoxil combining with lamivudine can play a synergistic therapeutic effect in patients with lamivudine-resistant CHB, it＇s effective, safe and reliable, but the renal function should be monitored during the treatment.