恩替卡韦联合阿德福韦酯治疗拉米夫定耐药慢性乙型肝炎的临床应用体会

Clinical Efficacy of Entecavir Combined with Adefovir Dipivoxil in Lamivudine-resistant Chronic Hepatitis B

目的:研究恩替卡韦(ETV)联合阿德福韦酯(ADV)治疗拉米夫定耐药慢性乙型肝炎(CHB)的临床疗效。方法:选择2012年1月-2013年12月于笔者所在医院治疗的CHB患者56例,采用随机数字表法将患者分为治疗组和对照组,每组28例。比较治疗前及治疗后第4、12、24、48周血浆HBV-DNA、ALT、AST、TBil、Alb及HBV血清学标志物(HBV M)、HBe Ag阴转率等指标及不良反应发生情况。结果:治疗组治疗后四个时间点ALT和AST均较对照组明显下降(P<0.05)。TBil在治疗后12周显著下降(P<0.05)。Alb在治疗后4周显著升高(P<0.05),其余观察点与对照组比较差异均无统计学意义(P>0.05)。治疗组四个时间点HBV DNA阴转率显著高于对照组(均P<0.05)。治疗组和对照组四个时间点HBe Ag阳性患者阴转率比较差异均无统计学意义(P>0.05)。治疗组治疗48周后耐药基因变异率为0,显著低于对照组的17.6%。两组不良反应发生率相比差异无统计学意义(P>0.05)。结论:ETV联合ADV治疗既往拉米夫定耐药的CHB患者疗效确切,多重耐药发生率更低,不良反应小,值得临床推广。

Objective： To investigate the clinical efficacy of Entecavir（ETV） combined with Adefovir Dipivoxil（ADV） in lamivudine-resistant chronic hepatitis B（CHB） patients.Method： 56 cases of CHB patients from January 2012 to December 2013 in our hospital were randomly divided into the treatment group and the control group, 28 cases in each group.The HBV-DNA, ALT, AST, TBil, Alb and HBV serological markers（HBV M）, HBeAg seroconversion rates and other indicators of adverse events were compared before and after treatment the first week 4, 12, 24, 48 plasma.Result： After treatment, ALT and AST four time points compared with the control group were significantly decreased（P〈0.05）.TBil 12 weeks after treatment was significantly d＇ecreased（P〈0.05）. Alb after 4 weeks of treatment was significantly higher（P〈0.05）, the rest of the observation points, compared with the control group, there were no significant differences（P〉0.05）.The treatment group of four time points HBV DNA negative rate was significantly higher（P〈0.05）.The treatment group and the control group of four time points in patients with HBeAg positive negative rate difference were no statistically significant（P〉0.05）.48 weeks after the treatment group was 0 resistance gene mutation was significantly lower than 17.6% in the control group.The incidence of adverse reactions compared two groups, there was no statistically significant difference（P〉0.05）.Conclusion： The ETV combined with ADV in lamivudine-resistant CHB patients has a lamivudine-resistant exact, lower incidence of muhi drug resistance and side effects ; which is worthy of promotion.