阿德福韦酯初治老年慢性乙型肝炎患者3年临床疗效和安全性观察

Observation of adefovir dipivoxil in treatment of elderly patients with chronic hepatitis B

目的观察阿德福韦酯初治老年慢性乙型肝炎患者的抗病毒疗效和安全性。方法选取2007年10月至2010年10月就诊的50例65岁以上老年慢性乙型肝炎患者,其中30例(A组)接受阿德福韦酯抗病毒治疗,另20例(B组)接受护肝治疗;另选择30例(C组)中年患者接受阿德福韦酯治疗。结果在治疗12 w时,A组(66.7%)和B组(60.0%)血清ALT复常率明显低于C组(83.3%,P<0.05);在治疗48 w时,A组(90.0%)与C组(93.3%)比,ALT复常率无显著性差异(P>0.05),但均高于B组(70.0%,P<0.05);在48 w时,A组血清HBV DNA阴转率(80.0%)明显高于C组(66.7%,P<0.05);3组患者在随访期间血肌酐水平变化的差异无统计学意义(P>0.05;3组患者在各时间点的平均肌酐水平差异无统计学意义,但在治疗96 w时,A组2例出现肌酐轻度升高,继续观察2个月后自行恢复正常,C组出现肌酐轻度升高3例,3个月内未恢复,给予ADV剂量减半后血肌酐均恢复正常,两组抗病毒治疗的患者均未见其它明显的不良反应。结论老年慢性乙型肝炎患者可选择阿德福韦酯抗病毒治疗,其疗效好,安全,与中年患者相比,无明显的肾功能损害。

Objective To observe the antiviral efficacy and safety of adefovir in the treatment of elderly patients with hepatitis B. Methods Fifty elderly patients aged over 65 year old with chronic hepatitis B （CHB） were divided into group A （n=30）and group B （n=20）,and thirty patients with hepatitis B aged （46.31±2.18） yr were selected in group C who took adefovir at dose of 10 mg daily as initial treatment as the same treatment as in group A. The three groups were observed at admission, 12 weeks,24 weeks,48 weeks,96 weeks and 144 weeks after treatment for virologic response and renal functions. All patients were followed-up for three years. Results At 24 weeks,there was no significant difference of liver normalization rates in group A （83.6%） and group C （86.7%）;At 48 weeks and 96 weeks,serum HBV DNA loss rate in group A was obviously higher than that in group C （80.0% and 80.0% vs. 60.0% and 66.7%,respectively,P〈O.05）;At the end of three years,there was no statistically significant difference of blood creatinine in the three groups;At 96 week treatment,2 patients in group A had blood creatinine levels mildly elevated,but returning to normal after 2 month observation,3 cases in group C had mild abnormal creatinine elevation,not recovered within three months,but got back to normal when the dosage of adefovir half-decreased. Conclusion The application of adefovir in elderly patients with chronic hepatitis B can improve liver functions,and have a good antiviral efficacy.