恩替卡韦联合阿德福韦酯治疗拉米夫定耐药的慢性乙型肝炎疗效观察

Therapeutic effects of entecavir combined with adefovir dipivoxil on lamivudine-resistant chronic hepatitis B

目的研究恩替卡韦联合阿德福韦酯对拉米夫定耐药的慢性乙型肝炎患者的疗效。方法将2011年1月至2013年1月就诊的拉米夫定耐药的慢性乙型肝炎患者160例,随机分为恩替卡韦(0.5 mg/d)联合阿德福韦酯(10 mg/d)组(A组,80例)和拉米夫定(100 mg/d)联合阿德福韦酯(10 mg/d)组(B组,80例)。完成12、24、48、96周治疗时,检测HBVDNA、HBeAg、HBsAg、ALT、肾功能、血常规及超声。结果治疗第12、24、48、96周时,HBVDNA<500 U/ml的患者,A组分别占55%、75%、80%、85%,B组分别占26.25%、42.5%、45%、60%(P<0.01);血清HBeAg转阴率:A组分别为12.25%、20.83%、35.4%、54.2%,B组分别为11.9%、17.4%、30.4%、50%。A组与B组相似,差异无统计学意义(P>0.05)。血清HBeAg转换率:A组分别为10.4%、16.67%、20.8%、27.1%,B组分别为10.8%、15.2%、17.4%、26.1%。A组与B组相似,差异无统计学意义(P>0.05)。A组与B组均无HBsAg转阴。ALT正常率:A组分别占65%、85%、90%、95%,B组分别占37.5%、57.5%、62.5%、80%,差异有统计学意义(P<0.05);脾脏厚度变小比率:在治疗第48、96周时2组差异有统计学意义(P<0.05);2组患者治疗过程中均未发现血清肌酐异常升高和血磷降低异常。结论恩替卡韦联合阿德福韦酯治疗拉米夫定耐药的慢乙肝患者,可在病毒学方面取得较好的疗效,且安全性良好。

Objective To investigate the therapeutic effects of entecavir(ETV)combined with adefovir dipivoxil(ADV)on lamivudine(LAM)-resistant chronic hepatitis B(CHB).Methods A total of 160 patients with LAM resistant CHB who were diagnosed and treated in our hospital from January 2011 to January 2013 were randomly divided ETV+ADV treatment group(group A,n=80)and LAM+ADV treatment group(group B,n=80).The patients in group A were treated by ETV(0.5mg/d)and ADV(10mg/d),however,the patients in group B were treated by LAM(100mg/d)and ADV(10mg/d).At 12w,24w,48w,96w after treatment,the levels of HBV-DNA,HBeAg,HBsAg,alanine aminotransferase(ALT),renal function,routine blood test and B-ultrasound were observed and compared between two groups.Results The proportion of the patients(HBV-DNA<500IU/ml)at 12w,24w,48w,96w after treatment in group A was 55%,75%,80%,85%,respectively,which was 26.25%,42.5%,45%,60%,respectively in group B(P<0.01).However there were no significant differences in HBeAg clearance rate and seroconversion rate between the two groups(P>0.05).In addition the ALT normal rate was 65%,80%,90%,95%,respectively in group A,however,which was 37.5%,57.5%,62.5%,80%,respectively in group B(P<0.05).Besides there was significant difference in the thickness of spleen at 48w,96w after treatment between two groups(P<0.05).Finally no abnormally increase of serum creatinine(Scr)and decrease of serum inorganic phosphorus during treatment were observed in both groups.Conclusion The combination treatment of ETV combined with ADV can achieve satisfactory therapeutic effects on LAM-resistant CHB,with better safety.