阿德福韦酯治疗经拉米夫定治疗后YMDD变异的慢性乙型肝炎患者48周疗效及相关因素分析

Analysis of 48 weeks effect and related factors of adefovir in the treatment of chronic hepatitis B patients with YMDD variant after lamivudine treatment

目的:探讨阿德福韦酯(ADV)治疗经拉米夫定(LAM)治疗后YMDD变异的慢性乙型肝炎患者48周疗效及相关因素。方法:收治经LAM治疗后YMDD变异的慢性乙肝患者100例,联合ADV治疗,观察治疗48周的疗效,分析相关因素。结果:48周HBV-DNA转阴、HBe Ag阳性患者e抗原转阴或转换和ALT复常者较未转阴者的基线HBV-DNA水平低,基线ALT水平≤IULN者48周可维持较高的ALT复常率和HBV-DNA转阴率,但48周HBe Ag阳性患者e抗原转阴或转换与基线ALT水平无相关性(P>0.05);基线HBV-DNA低水平、24周HBV-DNA转阴、12周YMDD变异转阴是48周疗效较好的预测因素。结论:对经LAM治疗后YMDD变异的慢性乙型肝炎患者,联合ADV治疗,其基线HBV-DNA低水平、24周HBV-DNA转阴、12周YMDD变异转阴是48周疗效较好的预测因素。

Objective：To explore the 48 weeks effect and related factors of adefovir（ADV） in the treatment of chronic hepatitis B patients with YMDD variant after lamivudine（LAM） treatment.Methods：100 patients with chronic hepatitis B and YMDD variant after lamivudine treatment were selected.They were treated with ADV.We observed the efficacy of the treatment for 48 weeks and analyzed the related factors.Results：Compared with those who did not turn negative,the baseline HBV-DNA level of patients with negative HBV-DNA and positive HBe Ag at 48 weeks and patients with e antigen turn negative or conversion and ALT recurrence was low.In patients of baseline ALT level less than or equal to IULN,48 weeks can maintain high ALT repetition rate and HBV DNA negative rate,but there was no correlation between the e antigen turn negative or conversion and baseline ALT level in patients with positive HBe Ag at 48 weeks（P〈0.05）.The low level of baseline HBV-DNA,24 weeks HBV-DNA turning negative,and 12 weeks YMDD variant turn negative were the predictors of better curative effect in 48 weeks.Conclusion：For chronic hepatitis B patients with YMDD variant after lamivudine treatment,combined with ADV treatment,the low level of baseline HBV-DNA,24 weeks HBV-DNA turning negative,and 12 weeks YMDD variant turn negative were the predictors of better curative effect in 48 weeks.