恩替卡韦联合阿德福韦酯治疗拉米夫定耐药的慢性乙型肝炎的疗效

Efficacy of entecavir combined with adefovir dipivoxil in the treatment of lamivudine-resistant chronic hepatitis B

目的 探讨恩替卡韦（ETV）联合阿德福韦酯（ADV）治疗拉米夫定耐药的慢性乙型肝炎（CHB）的疗效.方法 以2012年4月至2013年4月本院收治的拉米夫定耐药的CHB患者90例为研究对象,按随机数字表法分为ETV联合ADV治疗组（A组,n=48）和ETV治疗组（B组,n=42）.B组患者口服ETV（0.5 mg/d）,每天1次;A组患者在此基础上,联合应用ADV口服（10 mg/d）,每天1次,均持续用药48周.治疗前及治疗后12、24、48周检测HBV血清学标志物、血清HBV DNA、丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST） 、IL-10水平,计算生物化学应答率、病毒学应答率、HBeAg转阴率、HBeAg血清学转换率.结果 治疗后12、24、48周,两组患者HBVDNA及ALT水平均显著下降（均P＜0.05）,且上述各时点A组HBV DNA及ALT水平均显著低于B组（均P＜0.05）.治疗后24、48周,A组的生物化学应答率、病毒学应答率均显著高于B组（均P＜ 0.05）,但HBeAg转阴率及HBeAg血清学转换率差异无统计学意义（均P＞ 0.05）.治疗后12、24、48周,A组IL-10水平均显著低于B组（均P＜0.05）.结论 ETV联合ADV治疗拉米夫定耐药的CHB患者中期治疗效果较好.

Objective To investigate the efficacy of entecavir （ETV） combined with adefovir dipivoxil （ADV） in the treatment of patients with lamivudine-resistant chronic hepatitis B （CHB）.Methods Ninety lamivudine-resistant CHB patients admitted in our hospital from April 2012 to April 2013 were selected,and randomly divided into ETV combined with ADV treatment group （group A,n=48） and ETV treatment group （group B,n=42）.Patients in group B took ETV orally （0.5 mg/d） once per day for 48 successive weeks,and patients in group A took ADV orally （10 mg/d） once per day on the basis of the treatment of group B for 48 successive weeks also.The HBV serologic indicator,serum HBV DNA,alanine aminotransferase （ALT）,aspartate aminotransferase （AST）,IL-10 level were detected before treatment and 12,24 and 48 weeks after treatment,respectively.The biochemical response rate,virological response rate,HBeAg negative conversion rate,HBeAg serological conversion rate were calculated.Results The levels of HBV DNA and ALT in both groups decreased significantly 12,24 and 48 weeks after treatment （all P＜0.05）,and the levels of HBV DNA and ALT in group A were significantly lower than those in group B at each above time points （all P＜0.05）.The biochemical response rate,virological response rate in group A were significantly higher than those in group B 24 and 48 weeks after treatment （all P＜0.05）,while there was no statistical significance of HBeAg negative conversion rate and HBeAg serological conversion rate between two groups （all P＞0.05）.The serum IL-10 level in group A was significantly lower than those in group B 12,24 and 48 weeks after treatment （all P＜0.05）.Conclusion ETV combined with ADV has better efficacy in the middle stage of the treatment for lamivudine-resistant CHB patients.