摘要
目的:分析对阿德福韦酯(Adefovir dipivoxil,ADV)为基础的联合方案治疗失败的慢性乙型肝炎患者换用替诺福韦酯(Tenofovir disoproxil fumarate,TDF)优化治疗的长期疗效及安全性。方法:回顾性评价替诺福韦酯优化治疗50例对阿德福韦酯联合方案治疗失败患者的疗效及安全性。结果:50例患者年龄23.0~51.0(35.0±17.3)岁。基线平均血清HBV DNA水平为(4.8±1.6)log IU/mL。48例HBeAg阳性(96.0%)。50例患者中,ADV)联合拉米夫定(Lamivudine,LAM)、联合替比夫定替比夫定(Telbivudine, LdT)、联合恩替卡韦恩替卡韦(Entecavir,ETV)治疗失败的患者分别有17(34.0%)例、14(28.0%)例、19(38.0%)例。治疗失败后换用TDF优化治疗,经过24.0~192.0(102.0±47.3)周治疗,不同时间点的病毒学应答率为12周38.0%,24周70.0%,36周77.1%,48周87.2%,60周83.7%,72周85.7%,84周92.1%,96周90.3%,108周95.8%,ALT复常率为12周34.0%,24周44.0%,36周54.2%,48周57.9%,60周62.9%,72周66.7%,84周71.3%,96周77.0%,108周82.8%。48例基线 HBeAg阳性患者中,有5例(10.4%)发生HBeAg血清学转换。随访期间,6例患者出现病毒学突破,其中3例(2例TDF单药,1例TDF + ETV治疗)患者未能达到病毒学应答。没有严重不良事件发生。结论:对ADV为基础的联合治疗方案治疗失败的慢性乙型肝炎患者,换用TDF是一种安全、有效的优化治疗方案。
Objective:To analyze the efficacy and safety of tenofovir disoproxil fumarate (TDF ) switch therapy in chronic hepatitis B patients for suboptimal response to adefovir(ADV)-based combination therapy in real life. Methods:To evaluate the efficacy and safety of TDF switch therapy in 50 chronic hepatitis B patients after suboptimal response to ADV-based combination therapy. Results:The median follow-up duration was 102 weeks (24~192 weeks)and median age was 35 years (range,23 to 51). The mean serum HBV DNA level was 4.8±1.6 log IU/mL at baseline. 48 patients were HBeAg-positive (96%). 17(34%),14(28%),19(38%) patients was treated by prior lamivudine (LAM ) plus ADV,telbivudine (LdT ) plus ADV,ETV plus ADV, respectively. The cumulative probability of achieving virological response at 12,24,36,48,60,72,84,96, and 108 weeks were 38.0%,70.0%,77.1%,87.2%,83.7%,85.7%,92.1%,90.3%,95.8%,respectively. The cumulative probability of normal ALT at 12,24,48,60,72,84,96 and 108 weeks were 34.0%,44.0%,nbsp;54.2%,57.9%,62.9%,66.7%,71.3%,77.0%,82.8%. HBeAg seroconversion occured in 5 of 48 patients (10. 4%). During the follow-up,6 patients suffered from virological breakthrough,of whom 3 (2 cases was treated with TDF,and 1 case with TDf+ETV)failed to achieve virological response.No serious adverse event was reported. Conclusion:TDF switch therapy is an effective and safe for chronic hepatitis B patients with suboptimal response to ADV-based combination therapy in real-life.
出处
《广州医科大学学报》
2016年第4期39-42,共4页
Academic Journal of Guangzhou Medical University