拉米夫定与阿德福韦酯联用对慢性乙型肝炎患者的疗效及其对肝功能和血清HBV-DNA水平的影响

Clinical Efficacy of Combining Lamivudine and Adefovir Dipivoxil and Influence on Liver Function and Serum HBV-DNA in Patients with CHB

目的:评价拉米夫定与阿德福韦酯联用对慢性乙型肝炎(CHB)患者的临床疗效及其对肝功能和血清HBV-DNA水平的影响。方法:选取2016年2月—2017年3月间收治的CHB患者120例临床资料,将其随机分成对照组和观察组,每组60例;对照组患者给予拉米夫定治疗,观察组患者在对照组基础上加用阿德福韦酯治疗;比较两组患者治疗前和治疗6月、12月时HBV-DNA、HbeAg转阴率、肝功能复常率和YMDD基因的突变情况。结果:治疗前和治疗6月、12月时观察组患者HBV-DNA转阴率高于对照组(P<0.05),但是两组患者的HBeAg血清转换率及其转阴率经组间比较其差异无统计学意义(P>0.05);观察组患者治疗6月、12月时ALT复常率高于对照组(P<0.05),YMDD相关基因突变的发生率低于对照组(P<0.05)。结论:采用拉米夫定与阿德福韦酯联用治疗方案,其疗效优于单用拉米夫定,可有效改善了HBV耐药。

Objective： To evaluate the clinical efficacy of combining lamivudine and adefovir dipivoxil and influ- ence on liver function and serum HBV-DNA in patients with chronic hepatitis B（CHB）. Methods：120 patients with CHB, being in hospital from February in 2016 to March in 2017, were at random Separated into 2 groups （n=60）, control group （treatment with lamivudine） and observation group （treatment with lamivudine and adefovir dipivoxil）. The hepatitis B virus （HBV） DNA levels, Hepatitis B e-antigen （HBeAg）, liver function and tyrosine-methionine-aspartate-aspartate（YMDD） mutation were determined in the two groups before treatment and after treatment of 6 months and 12 months, respectively. Results： The HBV-DNA levels were decreased in the observation group （P〈 0.05）, but the rate of HBeAg seroconversion showed no significant difference. The HBV-DNA levels were decreased in the observation group （P〈 0.05）, but the rate of HBeAg seroconversion showed no significant difference in two groups. The renormalization rates of ALT were increased in the observation group after treatment of 6 months and 12 months（P〈0.05, respectively）, but the rate of YMDD mutation was decreased in the observation group （P〈0.05）. Conclusion： These findings suggest that, compared with treatment with lamivudine, the treatment with lamivudine and adefovir dipivoxil is more curative and it also could improve HBV drug resistance.