阿德福韦酯和拉米夫定治疗乙型肝炎肝硬化失代偿期的临床观察

目的观察阿德福韦酯和拉米夫定治疗肝炎肝硬化失代偿期患者48周的疗效和不良反应。方法采用随机分组法,将62例肝炎肝硬化失代偿期患者,随机分为阿德福韦酯组32例,给予阿德福韦酯10mg/d,拉米夫定组30例,给予拉米夫定100mg/d,疗程均为48周。均给予常规护肝及支持、对症治疗。观察两组患者的肝功能、HBeAg、HBV DNA、肝纤维化标志物Ⅲ型前胶原、Ⅳ型胶原、层黏连蛋白、透明质酸、肾功能及Child-Pugh分级、药物不良反应。结果两组患者肝功能各项指标的复常率、血清HBV DNA下降水平及转阴率、HBeAg转阴率及HBeAg/抗-HBe转换率均随着治疗疗程的延长而增加,但两组比较,差异无统计学意义。治疗至48周时拉米夫定组有2例发生YMDD变异,变异率6.7%,阿德福韦酯组无病毒变异发生。两组患者血清肝纤维化标志物治疗至24周时与治疗前相比明显下降,且随着疗程的延长进一步降低,两组比较差异无统计学意义。两组患者治疗前后Child-Pugh分级比较,差异无统计学意义。两组患者均未发现药物相关的肾功能损害,两组中各有2例患者出现轻度不良反应,但均能耐受。结论肝炎肝硬化失代偿期患者48周的抗病毒治疗,阿德福韦酯的疗效与安全性均与拉米夫定相似,而病毒耐药突变率较拉米夫定低。     

拉米夫定和阿德福韦酯初始联合及脐血干细胞治疗失代偿期肝硬化临床研究

目的探讨脐带血干细胞输注及拉米夫定（LAM）、阿德福韦酯（ADV）初始联合治疗失代偿期乙型肝炎肝硬化的临床效果。方法选择失代偿期乙型肝炎肝硬化患者56例,给予ADV10mg／d和LAM100mg／d口服,脐带血干细胞细胞悬液[含单个核细胞（15-35）×10^9／t]100ml静脉输注,每周1次,连续3次。治疗后将患者血常规、肝功能（ALT、AST、ALB、TBil、DBil）、病毒血清学指标进行比较。结果56例患者的肝功能（如ALT、AST、TB、ALB）等血清学指标,治疗前后差异有统计学意义（P〈0．05）,血常规（如WBC、PLT等）、HBVDNA载量比较差异有统计学意义（P〈0．05）。结论脐带血干细胞输注及LAM、ADV初始联合治疗失代偿期乙型肝炎肝硬化可迅速显著地抑制HBVDNA的复制,降低病毒载量,有效减轻肝脏的炎性反应,减少肝细胞坏死损伤,促进肝细胞再生,加速肝功能恢复。     

拉米夫定和阿德福韦酯初始联合与优化治疗失代偿期乙型肝炎肝硬化疗效观察

目的观察比较拉米夫定和阿德福韦酯初始联合或优化治疗失代偿期乙型肝炎肝硬化患者的效果及安全性。方法回顾分析2010年~2013年在我院就诊并采用拉米夫定(LAM)和阿德福韦酯(ADV)初始联合或优化治疗的失代偿期乙型肝炎肝硬化患者75例,比较两组患者治疗48 w后的临床疗效及安全性。结果在治疗48 w时,初始联合治疗组患者谷丙转氨酶(ALT)复常率和HBV DNA转阴率分别为84.0%和89.3%,显著高于优化组患者的46.0%和50.7%(P0.05);初始联合治疗组患者Child-Pugh评分新增A级和C级减少发生率分别为22.7%和12.0%,显著高于优化组的10.7%和5.3%(P0.05);初始联合治疗组腹水减少率为76.0%,显著优于优化组的56.0%(P0.05);两组在治疗前后肾功能、血浆肌酸激酶均无显著性变化。结论对于失代偿期乙型肝炎肝硬化患者,采用拉米夫定和阿德福韦酯初始联合治疗效果优于优化治疗。     

阿德福韦酯联合拉米夫定治疗代偿期乙型肝炎肝硬化疗效观察

目的 观察阿德福韦酯联合拉米夫定及拉米夫定单用治疗代偿期乙型肝炎肝硬化的疗效和安全性.方法 62例患者在保肝、对症支持等综合治疗的基础上分为A、B两组.A组(32例)每13口服阿德福韦酯10 mg和拉米夫定100 mg联合治疗,B组(30例)每日仅口服拉米夫定100 mg,疗程均为48周.观察患者治疗前后临床表现、生化学指标、病毒学及肝纤维化指标改变情况及不良反应.结果 62例患者治疗后病情稳定,肝功能恢复正常;A组HBV-DNA<103cp/ml者占62.5%,HBeAg阴转率达37.5%,病毒耐药突破率仅为3.1%(1例),B组HBV-DNA<10 3cp/ml者占53.3%,HBeAg阴转率为23.3%,病毒耐药突破率为16.6%(5例);两组血清透明质酸酶、Ⅲ型前胶原、层粘连蛋白、Ⅳ型胶原治疗后均明显降低(P<0.01),无明显不良反应出现.结论 阿德福韦酯联合拉米夫定治疗代偿期乙型肝炎肝硬化,可迅速抑制HBV-DNA的复制,促进肝功能恢复,病毒突破率低,安全性好.     

阿德福韦酯治疗乙型肝炎肝硬化失代偿期患者96周的临床观察

目的 研究阿德福韦酯和拉米夫定治疗乙型肝炎肝硬化失代偿期患者96周的疗效和不良反应.方法 乙型肝炎肝硬化失代偿期患者随机分为阿德福韦酯组和拉米夫定组,分别口服阿德福韦酯10 mg/d和拉米夫定100 mg/d,并均给予常规护肝及对症、支持治疗,疗程96周.观察48、72、96周时,两组患者的肝功能、HBeAg、HBV DNA、肝纤维化指标、病毒耐药突变率、Child-Pugh分级及并发症情况.两组间均数比较采用t检验,多组间均数比较采用方差分析,计数资料比较采用χ2检验.结果 治疗48周时,ALT、AST,白蛋白及总胆红素复常率,阿德福韦酯组分别为82.8%,86.2%、37.9%和82.8%,拉米夫定组分别为71.4%、85.7%、50.0%和75.0%,但两组间差异无统计学意义(χ2值分别为0.495、0.107、0.424和0.155,P值均＞0.05),且随着疗程的延长,患者肝功能指标复常率无明显变化.治疗48周时,两组患者的HBV DNA水平均较治疗前明显下降(t值分别为19.298和20.787,P值均＜0.01),但差异无统计学意义(P＞0.05).随着疗程的延长,阿德福韦酯组HBV DNA水平不断降低(F=6.34,P＜0.01),拉米夫定组无明显差异(F=1.10,P＞0.05).患者血清HBeAg转阴率及HBeAg/抗-HBe转换率随着治疗疗程的延长均增加,但两组间差异无统计学意义.96周时的病毒耐药突变率,拉米夫定组为25.0%,明显高于阿德福韦酯组的3.4%(χ2=3.843,P＜0.05).两组患者血清肝纤维化指标随着疗程的延长均维持较低水平,Child-Pugh分级在治疗至96周时均有所提高.治疗中的并发症发生率,阿德福韦酯组34.5%,拉米夫定组为28.6%,差异无统计学意义(χ2=0.038,P＞0.05).结论 阿德福韦酯对乙型肝炎肝硬化失代偿期患者的抗病毒疗效与安全性好,病毒耐药突变率低.     

拉米夫定与阿德福韦酯联合治疗失代偿期乙型肝炎肝硬化患者临床疗效研究

目的 探讨拉米夫定与阿德福韦酯后续或初始联合治疗失代偿期乙型肝炎肝硬化患者的疗效差异。方法 2014年5月~2016年5月收治的失代偿期乙型肝炎肝硬化患者100例,分为A组50例和B组50例,分别给予拉米夫定治疗24 w后再联合阿德福韦酯或初始即两药联合治疗,比较治疗48 w末两组血清HBVDNA转阴和ALT复常情况。结果 B组患者Child-Pugh评分、血清ALT、TBIL和ALB水平分别为（7.6±0.6）分,（65.8±10.1）U/L,（25.4±5.6）μmol/L和（32.3±0.8）g/L,与A组的（8.9±0.8）分,（87.3±21.0）U/L,（27.9±7.4）μmol/L和（32.3±0.6）g/L比,除了血清ALT水平明显低于A组(P<0.05)外,均无显著差异（P<0.05）;B组门静脉内径、脾静脉内径和脾厚度分别为（12.7±0.7）mm、（7.9±0.6）mm和（45.4±6.5）mm,与A组的（12.2±0.9）mm、（7.6±1.0）mm和（45.7±7.4）mm比,无显著差异（P<0.05）;B组血清HBVDNA转阴率和ALT复常率分别为90.0%和88.0%,均显著高于A组的54.0%和60.0%（P<0.05）。结论 相对于后续加用阿德福韦酯,初始联合拉米夫定和阿德福韦酯治疗失代偿期乙型肝炎肝硬化患者,可能提高血清HBV DNA阴转率和血清ALT复常率。     

阿德福韦酯联合拉米夫定对YMDD变异的失代偿期乙型肝炎肝硬化临床观察

目的观察比较阿德福韦酯联合拉米夫定和单用阿德福韦酯治疗YMDD变异的失代偿期乙型肝炎肝硬化的疗效和安全性。方法将30例在拉米夫定治疗过程中出现YMDD变异的失代偿期乙型肝炎肝硬化患者随机分为两组(各15例),联合组:继续接受拉米夫定100mg/d治疗,全程联合阿德福韦酯10mg/d口服;单用组:拉米夫定100mg/d和阿德福韦酯10mg/d联合治疗3月后单用阿德福韦酯10mg/d口服,疗程1年以上,两组在保肝基础治疗上无差异。结果治疗48周时结果显示,联合组肝功能ALT、ALB改善优于单用组(t分别为3.30、4.06,P<0.01),HBV DNA阴转率显著高于单用组(x2=3.89,P<0.05)。结论阿德福韦酯对YMDD变异的失代偿期乙型肝炎肝硬化患者有良好的疗效和安全性,联合拉米夫定疗效更显著,能明显提高患者的生存质量,改善预后。     

乙型肝炎肝硬化失代偿期患者抗病毒治疗的疗效分析

乙型肝炎后肝硬化一旦肝功能发生失代偿,其预后极差,5年的病死率高达70%～86%.因此,急需寻求有效的治疗对策.本研究旨在观察乙型肝炎肝硬化失代偿期患者分别采用拉米夫定(LAM)、阿德福韦酯(ADV)、恩替卡韦(ETV)单药治疗和LAM联合ADV治疗的疗效及不良事件发生率,探讨乙型肝炎肝硬化失代偿期的治疗策略.     

阿德福韦酯治疗慢性乙型肝炎、肝硬化代偿期和失代偿期患者2年疗效比较

目的观察慢性乙型肝炎（乙肝）、乙肝肝硬化代偿期和失代偿期患者接受阿德福韦酯（ADV）抗病毒治疗2年的疗效。方法对初治的慢性乙肝32例（慢性乙肝组）、乙肝肝硬化代偿期10例（肝硬化代偿期组）和失代偿期14例（肝硬化失代偿期组）应用ADV治疗2年,治疗前和治疗后每3个月检测Au等生化指标及HBVDNA等病毒学指标。结果3组患者在治疗前各项指标基线水平无显著差异,具有可比性。ADV治疗1年和2年时,3组ALT的复常率和HBeAg血清学转换率之间差异无统计学意义（P〉0．05）。治疗2年时慢性乙肝组HBVDNA水平下降的中位数为5．9log10 U／ml,肝硬化代偿期组为6．2log10 U／ml,肝硬化失代偿期组为2．9log U／ml。肝硬化失代偿期组在治疗6个月后的病毒学应答比慢性乙肝组和肝硬化代偿期组差。结论接受ADV治疗2年的慢性乙肝、肝硬化代偿期和失代偿期患者中,肝硬化失代偿期患者病毒学应答差。     

阿德福韦酯联合拉米夫定治疗失代偿性乙型肝炎肝硬化疗效观察

我院自2001年后试用拉米夫定治疗活动性、失代偿性乙型肝炎肝硬化并取得较好疗效,当部分患者出现YMDD变异产生耐药,改用阿德福韦酯口服治疗后,部分患者又发生阿德福韦酯耐药,引起病毒反弹及生化指标反弹。本组此类患者采用阿德福韦酯重新联用拉米夫定治疗取得很好疗效,报道如下：     

Lamivudine treatment of decompensated hepatitis B virus-related cirrhosis

BACKGROUND: Patients with decompensated hepatitis B vires (HBV)-related cirrhosis tend to have low or undetectable HBV replication. However, some patients continue to have high levels of HBV replication and effective suppression of HBV replication with antiviral agents may potentially decrease hepatic necroinflammation and improve or stabilize liver function. This review was to under stand the efficacy and safety of lamivudine in the treatment of decompensated HBV cirrhosis. DATA SOURCES: An English-language literature search (MEDLINE January 1988-July 2005) was performed, and a total of 52 articles/abstracts relevant to the issue were selected. After review of the selected papers, the meaningful results and conclusions were extracted using scientific crite ria. The papers reviewed pertained mainly to the efficacy and safety profiles of lamivudine treatment for decompensated HBV cirrhosis. RESULTS: The ultimate treatment of decompensated HBV cirrhosis is liver transplantation, but lamivudine treatment may lead to rapid suppression of viral replication and improvement of biochemical and clinical parameters, reduced morbidity and hospitalization for complications of liver disease, increased pre-transplant survival as well as reduced need for transplantation. However, viral resistance can develop after prolonged treatment with lamivudine, and breakthrough hepatitis may be fatal in few patients. Adefovir is effective for lamivudine-resistant HBV mutants. CONCLUSIONS: Antiviral therapy with lamivudine for decompensated HBV cirrhosis can be effective. However, some patients may experience a hepatitis flare with the emergence of YMDD mutants resulting in progressive worsening of liver disease, and should be referred for "rescue" therapy with other nucleoside/nucleotide analogues such as adefovir dipivoxil.     

宫内膜干细胞治疗失代偿期乙型肝炎肝硬化疗效的初步探讨

目的探讨宫内膜干细胞移植治疗失代偿期乙肝肝硬化患者的临床疗效。方法选择乙肝肝硬化失代偿期患者43例,随机分成两组,其中对照组30例,采用拉米夫定、阿德福韦酯抗病毒治疗;实验组13例,在对照组治疗基础上加用宫内膜干细胞治疗。分别在治疗后1、6、12个月检查各组患者肝脏功能、甲胎蛋白、胆碱酯酶、肝纤维化、凝血酶原时间,观察病毒学应答、临床症状及不良反应情况。结果治疗后1、6、12个月,实验组患者ALT、AST、TBIL、ALB、肝纤维化系列（LN、HA、PC-Ⅲ、Ⅳ）、CHE、PT等指标较对照组明显改善（ALT：F实验组=11.432,F对照组=8.231;AST：F实验组=13.197,F对照组=9.732;TBIL：F实验组=10.964,F对照组=8.692;Alb：F实验组=2.846,F对照组=3.691;CHE：F实验组=67.428,F对照组=70.285;LN：F实验组=20.462,F对照组=16.390;HA：F实验组=30.421,F对照组=23.521;PCⅢ：F实验组=23.532,F对照组=17.397;IV：F实验组=20.386,F对照组=15.496;PT：F实验组=1.752,F对照组=0.950。P均〈0.05）;治疗后12个月实验组和对照组HBVDNA阴转率和HBeAg血清转换率均较治疗后6月显著增加,且实验组显著优于对照组（P〈0.05）;两组患者治疗前后临床症状和体征均有所改善,治疗期间均未发现严重不良反应。结论采用宫内膜干细胞治疗乙肝肝硬化失代偿期患者,肝脏功能及临床症状明显改善,病毒应答率高,短期观察安全可靠,不良反应小,提高了患者的生活质量,值得临床进一步研究。     

乙型肝炎肝硬化失代偿期抗病毒治疗的研究进展

乙型肝炎肝硬化失代偿期是慢性乙型肝炎、肝纤维化发展的最终结局之一。大量的研究证明抗病毒治疗可以延缓病情进展,明显改善临床结局,减少并发症的发生,延缓失代偿肝硬化进程,最终提高生存期。核苷和核苷酸类药物是目前失代偿期乙型肝炎肝硬化的主要抗病毒药物。介绍了适用于乙型肝炎肝硬化失代偿期的抗病毒药物,针对治疗中的一些问题进行探讨,指出在临床工作中,在规范化抗病毒的前提下应遵循个体化治疗的原则。     

Tenofovir plus lamivudine as rescue therapy for adefovir‐resistant chronic hepatitis B in hepatitis B e antigen‐positive patients with liver cirrhosis

Background/Aims: There is no consensus on the management of patients with adefovir (ADV)‐resistant hepatitis B virus (HBV) infection. The aim of this study was to investigate whether tenofovir disoproxil fumarate (TDF) combined with lamivudine (LMV) is effective and safe in patients with resistance to or non‐response to ADV. Methods: Six patients with HBV‐related cirrhosis, viral breakthrough during LMV therapy and viral breakthrough or non‐response during ADV therapy were treated daily with TDF plus LMV for at least 6 months. The HBV DNA level, alanine aminotransferase (ALT), the Child–Pugh score and serum creatinine were monitored. Genotypic LMV‐ or ADV‐resistant mutations were measured in stored samples. Results: In five of six patients, ADV‐resistant mutations at rt181 or rt236 were detected during ADV therapy. At 6 months of starting TDF/LMV combination, HBV DNA levels became undetectable (detection limit, 400 copies/ml) in four of six patients. Within 12 months, HBV DNA levels became undetectable in all patients, and ALT levels were normalized in four of six patients. These responses persisted up to the end of the observation period (median duration 16.5 months, range 6–21 months). The Child–Pugh scores improved in two of three patients with hepatic decompensation. No significant changes in serum creatinine were observed. Conclusion: Our data demonstrated that TDF plus LMV safely and markedly suppressed HBV replication in patients with resistance to or non‐response to ADV. This study suggests that this combination may be a promising rescue therapy for these patients, particularly those with liver cirrhosis or pre‐existing LMV resistance.     

Favorable outcome of de novo hepatitis B infection after liver transplantation with lamivudine and adefovir therapy

Abstract: De novo hepatitis B virus (HBV) infection after orthotopic liver transplantation (OLT) always progresses to chronic hepatitis because of the patients' immunocompromised status, and only a few then acquire hepatitis B surface antigen (HBsAg) seroconversion even with efficient antiviral therapy. Here we reported the case of a liver transplant recipient with de novo HBV infection who had a favorable outcome after lamivudine (LAM) and adefovir dipivoxil (ADV) antiviral therapy. The patient received OLT because of end‐stage primary biliary cirrhosis and was found to have de novo HBV infection 3 months later. She was treated with LAM, and her serum HBV DNA turned undetectable 2 weeks later. However, serum HBV DNA turned detectable again after 9 months of LAM therapy and a YMDD mutation was detected. The addition of ADV was efficient to treat LAM‐resistant HBV. After 3 months of combination therapy, LAM was stopped and ADV monotherapy was continued. HBsAg seroconversion was achieved after an additional 12 months. The prevention and treatment of de novo HBV infection after OLT is discussed.     

抗病毒治疗对失代偿期乙型肝炎肝硬化患者经颈静脉肝内门体分流术预后的影响

目的探讨抗病毒治疗对失代偿期乙型肝炎肝硬化患者经颈静脉肝内门体静脉分流术(TIPS)预后的影响。方法回顾性分析2008年1月-2011年12月行TIPS预防静脉曲张破裂再出血的失代偿期乙型肝炎肝硬化患者110例,按其是否使用抗病毒药物,分为TIPS联合抗病毒组(58例)与TIPS组(52例),计量资料组间比较采用t检验或Wilcoxon秩和检验,计数资料组间比较采用χ2检验,累积生存率、再出血率、支架通畅率和肝细胞癌发生率采用Kaplan-Meier生存分析及log-rank检验。结果 TIPS联合抗病毒组和TIPS组患者TIPS术后1、3和5年累积生存率分别为93.1%、86.1%、77.7%和88.5%、64.9%、59.7%,TIPS联合抗病毒组的累积生存率显著优于TIPS组(χ2=6.833,P=0.009)。TIPS联合抗病毒组的病毒学应答率随着抗病毒治疗时间的延长而逐渐升高。两组累积静脉曲张再出血率、支架通畅率、肝细胞癌发生率的差异均无统计学意义(P值均0.05)。结论抗病毒治疗可改善失代偿期乙型肝炎肝硬化TIPS术后患者的生存率。     

Antiviral therapy for hepatitis B virus‐related decompensated cirrhosis

Antiviral therapy is important in patients with hepatitis B virus (HBV)‐related decompensated cirrhosis. This therapy is beneficial in most patients for the stabilization or improvement of liver disease; however, advanced cirrhosis with a high Child–Pugh or model for end‐stage liver disease (MELD) score may have progressed and does not benefit from antiviral therapy. It is important to identify patients with severe decompensated cirrhosis who will not improve under antiviral therapy and who require liver transplantation as early as possible. Entecavir (ETV) or tenofovir disoproxil fumarate (TDF) is the first‐line therapy for nucleos(t)ide analogue (NA)‐naive patients with decompensated cirrhosis due to their potent and prompt HBV suppressive effect and low rate of drug‐resistant mutations. Patients on antiviral therapy should be monitored for virological and clinical response, compliance, drug resistance and adverse effects as well as surveillance for hepatocellular carcinoma (HCC). Additional studies of TDF and ETV are necessary to determine the optimal agent(s) for treating naive patients and those with drug‐resistant decompensated cirrhosis. In order to evaluate the effectiveness of NA for the treatment of decompensated cirrhotic patients in the real world, high quality observational studies such as registration studies of antiviral therapy for HBV‐related cirrhosis and a long‐term follow‐up in China, where a large number of such patients are found, are recommended.     

长期抗病毒治疗对失代偿期乙型肝炎肝硬化患者预后的影响

目的观察失代偿期乙型肝炎肝硬化患者长期抗病毒治疗疗效。方法将78例乙型肝炎肝硬化失代偿期患者随机分为治疗组46例、对照组32例,治疗组给予拉米夫定(100 mg/d)、阿德福韦酯(10 mg/d)、替比夫定(600 mg/d)或恩替卡韦(0.5 mg/d)口服,同时予以保肝、支持及对症治疗;对照组仅给予常规保肝、对症及支持治疗。随访结束时比较2组治疗前后Child-Pugh分级的变化、血清肝功能指标、肝纤维化指标及临床结局。结果治疗组丙氨酸转氨酶、天冬氨酸转氨酶和总胆红素均较治疗前下降,白蛋白及胆碱酯酶(CHE)较治疗前升高,对照组治疗后CHE水平下降(P均<0.05)。治疗组治疗后39例(84.78%)Child-Pugh分级下降,肝纤维化指标较治疗前下降(P均<0.05)。两组发生肝癌比例分别为2.17%和21.88%,比较差异有统计学意义(P<0.05)。结论失代偿期乙型肝炎肝硬化患者通过长期抗病毒治疗可以改善肝功能,改善预后,降低肝癌发生机会,延缓肝移植需求。     

阿德福韦酯治疗慢性乙型肝炎85例不良反应观察

目的观察阿德福韦酯治疗慢性乙型肝炎的不良反应。方法 2007年12月至2012年2月慢性乙型肝炎患者共120例,排除失代偿性肝病、原发性或继发性泌尿系统疾病。所有病例治疗前无尿常规及肾功能异常。其中单一使用常规剂量阿德福韦酯治疗的初治病例85例（A组）,其余35例患者予以拉米夫定或恩替卡韦治疗（B组）。治疗过程中起初12周每4周复查血尿常规及肝肾功能,之后每12周复查血尿常规、肝肾功能、血磷、血清肌酸激酶及淀粉酶等。结果 A组9例（10.59%）出现尿常规异常,包括蛋白尿、镜下血尿等,其中一过性异常5例（5.88%）,持续异常4例（4.71%）。B组有1例（2.86%）一过性尿蛋白阳性。两组尿检异常率及持续尿检异常率对比差异均无统计学意义（P〉0.05）。A组5例（5.88%）尿素氮（BUN）升高,B组1例（2.86%）BUN升高,均为一过性,两组对比差异无统计学意义（P〉0.05）。无血清肌酐（SCr）升高病例,未见其他不良反应。结论常规剂量阿德福韦酯治疗慢性乙型肝炎安全性良好。少数病例出现持续性尿检异常,可考虑换药。     

Adefovir dipivoxil for the treatment of lamivudine-resistant hepatitis B mutants

BACKGROUND: The recurrence of chronic hepatitis B after liver transplantation results in increased risk for graft failure and death of patients. Lamivudine has been shown to be effective in the treatment of chronic hepatitis B, but resistance to this agent is common after prolonged administration. METHODS: One patient with chronic hepatitis B virus (HBV) infection developed resistance to lamivudine after 15 months of treatment. The resistance was confirmed by mutation in the HBV DNA polymerase gene. The patient was treated subsequently with adefovir dipivoxil for 7 months. RESULT: HBV DNA and HBsAg were tested negative, but HBeAb and HBsAb were positive. CONCLUSION: This study provides an evidence that adefovir dipivoxil can be effective in the treatment of lamivudine-resistant HBV mutants.