替比夫定治疗慢加亚急性乙型肝炎肝衰竭的疗效观察

目的：探讨替比夫定治疗慢加亚急性乙型肝炎肝衰竭患者104周的临床疗效和基因变异情况。方法共纳入80例慢加亚急性乙型肝炎肝衰竭患者,治疗组41例,对照组39例,分别在常规治疗的基础上使用替比夫定、拉米夫定治疗,每3～6个月进行HBV DNA、ALT、TBIL、INR及HBeAg检测,判断疗效。结果在治疗52周和104周时,治疗组HBeAg转阴率分别是54．2％和62．5％,与对照组HBeAg转阴率和转换率16．0％和20．0％比较差异有统计学意义（ P＜0．05）。结论替比夫定能够迅速抑制HBV复制,HBeAg血清学转阴率和转换率高,能阻断病情发展,适合慢加亚急性乙型肝炎肝衰竭患者治疗。     

Long-term lamivudine therapy for chronic hepatitis B in patients with and without cirrhosis

STUDY OBJECTIVE: To evaluate the effects and safety of 52-week lamivudine therapy in Korean patients with chronic hepatitis B virus (HBV), with and without cirrhosis. DESIGN: Long-term retrospective study. SETTING: Ajoo University Medical Center, Soowon, Korea. PATIENTS: Twenty-seven men and two women who had received oral lamivudine 100 mg/day for 52 weeks for treatment of biopsy-proven chronic HBV; 11 patients had cirrhosis, 18 did not. MEASUREMENTS AND MAIN RESULTS: All 29 patients were positive for HBV DNA and hepatitis B surface antigen (HBsAg) before treatment began; 25 (86%) patients were positive for hepatitis B e antigen (HBeAg). Lamivudine therapy suppressed serum HBV DNA to undetectable levels in 26 (90%) patients within a median of 4 weeks. Serum HBV DNA of 28 patients (97%) fell significantly to undetectable levels within 12 weeks and remained undetectable in 24 (83%) patients after 52 weeks, and HBeAg had converted to negative in 10 (40%) of the 25 patients who were positive. Mean serum alanine aminotransferase (ALT) levels of the 29 patients decreased to within the normal range by 12 weeks and remained at 33-48 IU/L thereafter. Differences in responses of HBV DNA and ALT to lamivudine therapy in HBeAg-positive and -negative patients were negligible (p = 0.786 and p = 0.225, respectively). Pretreatment HBV DNA and ALT levels had no effect on the efficacy of lamivudine (p = 0.9116). Furthermore, differences in responses of HBV DNA (p = 0.641), HBeAg seroconversion (p = 0.386), and ALT (p = 0.689) and in development of drug resistance (p = 0.617) between patients with and without cirrhosis were negligible. No serious adverse effects were reported. CONCLUSION: Lamivudine is an effective and well-tolerated therapeutic agent for treating chronic HBV in patients with and without cirrhosis.     

Lamivudine treatment for fulminant hepatic failure due to acute exacerbation of chronic hepatitis B infection

BACKGROUND: Exacerbation of chronic hepatitis B infection can lead to fulminant hepatic failure with a mortality of up to 90%. AIM: To evaluate the efficacy of lamivudine in the treatment of this subgroup of patients. METHODS: Twenty-four patients with exacerbation of chronic hepatitis B infection and fulminant hepatic failure were treated with lamivudine, 100 mg daily. Hepatitis A, C, D and human immunodeficiency virus co-infections and hepatocellular carcinoma were excluded. RESULTS: The median age was 53 years (range, 24-77 years) with a male predominance of 20:4. Seventeen patients were hepatitis B e antigen positive. Mean hepatitis B virus DNA was 2079 Meq/mL. Eight patients (33%) survived (group A). Thirteen patients died and three patients received liver transplantation (67%) (group B). Baseline laboratory results were comparable between the two groups, including serum albumin, bilirubin, alanine aminotransferase, prothrombin time and creatinine. Group B patients had significantly more comorbid illnesses at baseline and more complications, including sepsis and renal failure, compared with group A patients. Six out of eight survivors (75%) had full hepatitis B e antigen seroconversion, but this was not sustained in four patients. CONCLUSIONS: Lamivudine may be useful in treating patients with fulminant hepatic failure due to exacerbation of chronic hepatitis B. Hepatitis B e antigen seroconversion was less durable in this subgroup of patients and long-term therapy may be required.     

Lamivudine. A review of its therapeutic potential in chronic hepatitis B.

Lamivudine is a deoxycytidine analogue that is active against hepatitis B virus (HBV). In patients with chronic hepatitis B, lamivudine profoundly suppresses HBV replication. Clinically significant improvements in liver histology and biochemical parameters were obtained with lamivudine in double-blind, randomised, trials in hepatitis B e antigen (HBeAg)-positive patients with chronic hepatitis B and compensated liver disease. After 52 weeks of treatment, relative to placebo (< or = 25%), significantly more Chinese (56%) or Western patients (52%) treated with lamivudine 100 mg/day had reductions of > or = 2 or more points in Knodell necro-inflammatory scores. Moreover, significantly fewer lamivudine 100 mg/day than placebo recipients had progressive fibrosis in liver biopsies (< or = 5 vs > or = 15%) and fewer lamivudine- than placebo-treated patients progressed to cirrhosis (1.8 vs 7.1%). More lamivudine 100 mg/day than placebo recipients acquired antibodies to HBeAg after 52 weeks (16 vs 4% in Chinese patients and 17 vs 6% in Western patients). ALT levels normalised in significantly more lamivudine than placebo recipients enrolled in these trials. In HBeAg-negative, HBV DNA positive patients with compensated liver disease enrolled in a double-blind, randomised study, HBV DNA levels were suppressed to below the limit of detection (< 2.5 pg/ml) and ALT levels normalised in 63% and 6% of patients treated with lamivudine 100 mg/day or placebo for 24 weeks. Clinically significant improvements in liver histology were obtained in 60% of patients treated with lamivudine for 52 weeks in this study. Lamivudine 100 mg/day for 52 weeks produced similar or significantly greater improvements in liver histology and ALT levels than 24 weeks' treatment with lamivudine plus interferon-alpha. In liver transplant candidates with chronic hepatitis B and end-stage liver disease, lamivudine 100 mg/day alone, or in combination with hepatitis B immune globulin, generally suppressed HBV replication and appeared to protect the grafted liver from reinfection. Lamivudine 100 mg/day suppressed viral replication and improved liver histology in liver transplant recipients with recurrent or de novo chronic hepatitis B. Lamivudine 300 or 600 mg/day reduced HBV replication in HIV-positive patients. The incidence of adverse events in patients with chronic hepatitis B and compensated liver disease treated with lamivudine 100 mg/day or placebo for 52 to 68 weeks was similar. 3.1- to 10-fold increases in ALT over baseline occurred in 13% of patients during treatment with lamivudine 100 mg/day or placebo for 52 weeks. Post-treatment ALT elevations were more common in lamivudine than placebo recipients; however, these generally resolved spontaneously; < or = 1.5% of lamivudine- or placebo-treated patients experienced hepatic decompensation. CONCLUSION: Lamivudine inhibits HBV replication, reduces hepatic necro-inflammatory activity and the progression of fibrosis in patients with chronic hepatitis B, ongoing viral replication and compensated liver disease including HBeAg-negative patients. The drug also suppresses viral replication in liver transplant recipients and HIV-positive patients. Thus, lamivudine is potentially useful in a wide range of patients with chronic hepatitis B and ongoing viral replication.     

干扰素α联合拉米夫定治疗慢性乙型肝炎疗效观察

目的:观察干扰素α联合拉米夫定治疗慢性乙型肝炎的疗效。方法:72例慢性乙型肝炎患者随机分为治疗组与对照组。治疗组35例,同时使用干扰素α及拉米夫定26wk后,再单独使用拉米夫定26wk;对照组37例,单独使用拉米夫定52wk。结果:治疗组与对照组HBeAg转阴率分别为42.86%、27.03%(P>0.05),HBVDNA转阴率分别为94.29%、62.16%(P<0.05)。结论:干扰素α联合拉米夫定治疗慢性乙型肝炎效果略优于单独使用拉米夫定。     

48 weeks pegylated interferon alpha-2a is superior to 24 weeks of pegylated interferon alpha-2b in achieving hepatitis B e antigen seroconversion in chronic hepatitis B infection

BACKGROUND/AIM: Although 48-week therapy with pegylated-interferons has been shown to be effective for the treatment of chronic hepatitis B virus infection, the efficacy of a shorter duration of therapy with pegylated interferons is unknown. METHOD: We reviewed 53 hepatitis B e antigen positive Chinese patients treated with 48 weeks of pegylated interferon alpha-2a or 24 weeks of pegylated interferon alpha-2b. Sustained virological response was defined as hepatitis B e antigen seroconversion and hepatitis B virus DNA <10(5) copies/mL at week 72. RESULTS: Twenty-nine patients were treated with 48 weeks of pegylated-interferon-alpha-2a and 24 patients with 24 weeks of pegylated-interferon-alpha-2b. At the end-of-therapy, hepatitis B e antigen seroconversion and hepatitis B virus DNA <10(5) copies/mL were similar between the two groups of patients [9/29 (31.0%) vs. 2/24 (8.3%), respectively, P = 0.09]. At week 72, 10 of the 29 patients (34.5%) treated with 48 weeks of pegylated-interferon-alpha-2a compared with two of the 24 patients (8.3%) treated with 24 weeks of pegylated-interferon-alpha-2b had sustained virological response (P = 0.04). By logistic analysis, 48 weeks of pegylated-interferon-alpha-2a was independently associated with sustained virological response (P = 0.04 adjusted hazards-ratio 9.37). CONCLUSION: Further studies are required to determine the optimal duration of therapy with pegylated interferons in chronic hepatitis B.     

慢性乙型肝炎中医证型与拉米夫丁应答的关系

目的:评价慢性乙型肝炎不同的中医辩证分型与拉米夫丁抗病毒效应的关系。方法:选择慢性乙型肝炎84例,按中医辨证分肝胆湿热42例、肝郁脾虚42例。两组均以拉米夫丁100mg,qd,口服观察用药后第1、2、4、,8、12、52周病人血清乙肝两对半定性和HBV-DNA定量。结果:治疗12周后肝胆湿热、肝郁脾虚两组的HBV-DNA累计阴转率分别为90.6%和71.9%,治疗52周后两组的HBeAg阴转率分别为肝胆湿热65.6%、肝郁脾虚40.6%,P<0.05。HBeAg/抗HBe转换率分别为肝胆湿热34.4%、肝郁脾虚15.6%,P<0.05。结论:慢性乙型肝炎不同的中医辩证分型与拉米夫丁抗病毒效应有一定的相关性。     

Adefovir dipivoxil added to ongoing lamivudine therapy in patients with lamivudine-resistant hepatitis B e antigen-negative chronic hepatitis B

BACKGROUND: Long-term treatment with lamivudine is required to control viral replication in patients with hepatitis B e antigen-negative chronic hepatitis B, but is associated with a high rate of viral resistance. The role of adefovir dipivoxil in these patients has not been definitively evaluated. AIM: To address the role of adefovir in the management of patients with lamivudine-resistant hepatitis B e antigen-negative chronic hepatitis B. METHODS: Patients were assigned to receive adefovir 10 mg once daily plus ongoing lamivudine 100 mg once daily for 52 weeks. The primary end point was reduction in serum hepatitis B virus DNA level (hepatitis B virus DNA response). Secondary end points included the proportion of patients with undetectable hepatitis B virus DNA at week 52 (complete virological response) and the percentage of patients with normalization of alanine transferase level at week 52 (biochemical response). RESULTS: A total of 49 consecutive patients were enrolled in this study. After 52 weeks of treatment, all patients had an hepatitis B virus DNA response and 57.1% had complete virological response. Biochemical response occurred in 75.6% of patients. CONCLUSIONS: Administration of adefovir in patients with lamivudine-resistant chronic hepatitis B results in significant suppression of viral replication. Nevertheless, continuous therapy will probably be needed in order to maintain remission in these patients.     

拉米夫定抗病毒治疗快速病毒学应答与一年疗效的相关性分析

目的分析慢性乙型肝炎（CHB）患者使用拉米夫定（LMD）抗病毒治疗后出现快速病毒学应答（RVR）对一年乙型肝炎病毒脱氧核糖核酸（HBVDNA）转阴率、乙肝病毒e抗原（HBeAg）血清转换率、丙氨酸转氨酶（ATJT）复常率和耐药发生率的预测价值,探讨临床实用的疗效预测指标。方法70例HBeAg阳性患者服用LMD抗病毒治疗4周时定量检测HBVDNA,将HBVDNA〈310g10cp／ml患者18例和HBVDNA≥310g10cp／ml患者52例作为I组和Ⅱ组分层观察,治疗52周时,检测血清HBVDNA,ALT,HBV血清标志物和HBV多聚酶氨基酸序列酪氨酸-蛋氨酸-天门冬氨酸-天门冬氨酸（YMDD）变异。结果治疗52周时的血清HBVDNA转阴率：I组为88．9％,Ⅱ组为44．2％;HBeAg血清转换率：I组为44．4％,Ⅱ组为11．5％;YMDD变异率：I组为0,Ⅱ组为21．2％;ALT复常率：I组为94．4％,Ⅱ组为76．9％。经统计学分析,HBVDNA转阴率、HBeAg血清转换率、YMDD变异率两组之间有显著差别。结论LMD治疗4周时出现RVR可预测一年疗效,并且有可能更好的指导临床医生合理使用核苷类似物治疗CHB。     

拉米夫定治疗4周检测乙型肝炎病毒DNA水平预测104周疗效的价值

目的探讨拉米夫定治疗4周检测血清乙型肝炎病毒(HBV)DNA水平对远期疗效的预测价值。方法入选80例YMDD阴性的乙型肝炎病毒e抗原(HBeAg)阳性慢性乙型肝炎(CHB)患者,男56例,女24例,接受拉米夫定100mg/d治疗。分别在治疗4、24和104周时,检测血清HBVDNA,HBV标志物和YMDD。根据血清HBVDNA水平,以4周和24周时HBVDNA<500拷贝/ml为界,将不同HBVDNA水平患者分Ⅰ组和Ⅱ组,104周后检测和分析2组HBVDNA转阴率、HBeAg血清转换率和YMDD变异率的差别。结果血清HBVDNA转阴率:Ⅰ组为89%,Ⅱ组为25%(χ2=11.79,P<0.01);HBeAg血清转换率:Ⅰ组为44%,Ⅱ组为12%(χ2=1.63,P>0.05);YMDD变异率:Ⅰ组为3%,Ⅱ组为38%(χ2=5.81,P<0.05)。结论拉米夫定治疗4周时HBVDNA下降到检测下限(500拷贝/ml)可预测104周的疗效。     

复方甘草酸苷联合拉米夫定治疗慢性乙型肝炎的疗效观察

目的:观察复方甘草酸苷对慢性乙型肝炎患者血清病毒学标志的影响。方法:60例慢性乙型肝炎患者随机分为对照组和治疗组,前者给予拉米夫定,后者在此基础上加用复方甘草酸苷,观察用药后血清病毒学标志及肝功能指标的变化。结果:治疗12周时治疗组血清HBeAg/抗-HBe转换率明显高于对照组;治疗12周、24周时治疗组肝功能指标复常率明显高于对照组。结论:复方甘草酸苷辅助治疗慢性乙型肝炎可促进患者HBeAg/抗-HBe血清转换。     

Telbivudine

Telbivudine, the unmodified L-enantiomer of the naturally occurring nucleoside D-thymidine, is a potent synthetic nucleoside analogue. It acts as a hepatitis B virus (HBV) polymerase inhibitor and preferentially inhibits HBV second strand (DNA-dependent) compared with first strand (RNA-dependent) DNA synthesis. More telbivudine than lamivudine recipients with hepatitis B e antigen (HBeAg)-positive chronic hepatitis B and similar proportions of telbivudine or lamivudine recipients with HBeAg-negative disease achieved a therapeutic response at 52 weeks in the large 2-year GLOBE trial. In a phase III trial in Chinese patients, greater reductions in serum HBV DNA occurred with telbivudine than lamivudine at 52 weeks. Reductions in serum HBV DNA at 24 weeks were greater with telbivudine than adefovir in the 1-year switching trial. A lower residual viral load at 52 weeks was seen in patients who received telbivudine or who switched from adefovir to telbivudine at 24 weeks than in patients receiving adefovir. In the 1-year lamivudine switching trial in patients with serum HBV DNA levels >3 log10 copies/mL despite having received prior treatment with lamivudine for a mean of [almost equal or equal to]7 months, those randomised to telbivudine therapy achieved greater reductions in serum HBV DNA levels at 24 weeks than patients randomised to continue lamivudine therapy. Telbivudine was generally well tolerated and most adverse events were of mild or moderate severity. The incidence of severe ALT flares with telbivudine was half that seen with lamivudine at both 52 and 104 weeks in the GLOBE trial.     

Prophylactic lamivudine prevents hepatitis B reactivation in chemotherapy patients

BACKGROUND: Chronic hepatitis B virus carriers receiving chemotherapy develop a high hepatitis B virus reactivation rate (38-53%) with a high mortality (37-60%). Few studies have characterized the efficacy of lamivudine in the treatment of chemotherapy-induced hepatitis B virus reactivation. AIM: To determine whether lamivudine prophylaxis reduces chemotherapy-induced hepatitis B virus reactivation and mortality. METHODS: The medical records of all hepatitis B surface antigen-positive patients with malignancy treated with chemotherapy since 1995 at the National University Hospital of Singapore were identified, and divided into those who received lamivudine prophylaxis before chemotherapy (P) and those who did not (NP).The parameters examined included gender, age, malignancy type, steroid usage, number of chemotherapy courses and regimens, follow-up duration and hepatitis B virus status. The outcome measures were hepatitis B virus reactivation (abrupt rise of serum alanine aminotransferase to > 200 IU/L) and reactivation death. Patients with primary hepatoma or liver metastasis were excluded. RESULTS: Thirty-five patients were identified: 16 in the P group and 19 in the NP group. The baseline characteristics of the two groups were similar. Seven of the 19 patients in the NP group and none of the 16 patients in the P group developed reactivation (36.8% vs. 0%, P=0.009). Six of the seven patients in the NP group who developed reactivation received lamivudine at that time, but five died (mortality, 71.4%), whilst no patient in the P group died from reactivation (P=0.064). CONCLUSIONS: Prophylactic lamivudine appears to prevent hepatitis B virus reactivation and its associated mortality in patients treated with chemotherapy. This should be confirmed with prospective studies.     

替比夫定治疗HBeAg阳性慢性乙型肝炎的临床观察

目的 观察替比夫定治疗HBeAg阳性慢性乙型肝炎的临床疗效及安全性.方法 对210例门诊治疗的HBeAg阳性慢性乙型肝炎患者进行回顾性分析,将其根据治疗方法分为2组,替比夫定组104例(应用替比夫定600 mg/d治疗),拉米夫定组106例(应用拉米夫定100 mg/d治疗).2组均治疗52周,观察两药对血清HBV DNA、HBV血清学标志物、肝脏生物化学指标的影响及安全性.根据患者治疗12和24周HBV DNA的水平来预测影响疗效的因素.结果 治疗52周后,替比夫定组血清HBV DNA检测不到率、HBeAg转阴率、HBeAg转换率、ALT复常率、病毒学突破率和病毒学反弹率均优于拉米夫定组,差异性有统计学意义[70.2％ (73/104)比56.6％ (60/106);35.6％ (37/104)比12.3％ (13/106);22.1％ (23/104)比11.3％ (12/106);77.9％ (81/104)比55.7％ (59/106);6.7％ (7/104)比16.0％ (17/106);2.9％ (3/104)比10.4％ (11/106);P ＜0.01或P＜0.05].替比夫定治疗24周,HBV DNA水平＜500拷贝/ml的患者,52周HBV DNA检测不到率和病毒学反弹率,优于≥500拷贝/ml的患者,差异具有统计学意义(P＜0.05).结论 替比夫定对HBeAg阳性慢性乙型肝炎的疗效优于拉米夫定,能迅速持续抑制HBV的复制,使HBeAg转换,肝功能恢复正常,不良反应较少,患者耐受性好,可以长期治疗慢性乙型肝炎,在治疗中应注意监测肌酸激酶.     

阿德福韦酯治疗HBeAg阳性的慢性乙型肝炎38例

目的观察阿德福韦酯对HBeAg阳性的慢性乙型肝炎患者的临床疗效及耐药情况。方法将70例患者随机分为两组,治疗组38例给予阿德福韦酯片10mg,对照组32例给予拉米夫定片0．1g,两组均为1次／d,服用48周。治疗24周和48周后观察丙氨酸氨基转移酶（ALT）复常率、HBeAg的阴转率及血清学转换率、HBV—DNA定量、HBV—YMDD变异株。结果两组临床疗效无显著差异（P〉0．05）。治疗组在治疗过程中未发现肝功能再次异常,无耐药情况发生;对照组在治疗24周后肝功能轻度反弹,且出现病毒变异株。结论阿德福韦酯治疗HBeAg阳性的慢性乙型肝炎耐药率低,疗效较好。     

拉米夫定与α-干扰素序贯治疗慢性乙型肝炎疗效观察

目的探讨拉米夫定与α-干扰素序贯治疗慢性乙型肝炎（chronic hepatitis B,CHB）疗效。方法98例HBeAg阳性CHB患者随机分成A、B两组。A组用拉米夫定100mg.d^-1口服,8周后联合α-干扰素5MIUsc,隔日1次,治疗8周,最后单用α-干扰素5MIU16周;B组单用α-干扰素5MIUsc,隔日1次,共24周;两组患者在α-干扰素停药后随访6个月。结果结束时,A组HBeAg转阴率、HBeAg转换率、ALT复常率、HBV DNA转阴率、HBV DNA〈105与B组比较,P值均〈0.05;但完全应答率无差异;而随访6个月时,A、B两组各指标均无差异。结论拉米夫定与α-干扰素二者序贯治疗CHB短期疗效优于单一α-干扰素治疗。     

Review article: current management of chronic hepatitis B

Chronic hepatitis B can be diagnosed in patients with increased aminotransferases, hepatitis B virus viraemia and necroinflammation with fibrosis on liver biopsy. Although, ideally, all patients with chronic hepatitis B should be treated, therapeutic intervention is currently recommended for cases with a relatively satisfactory likelihood of response and/or advanced disease. A realistic therapeutic approach aims to sustain hepatitis B e antigen (HBeAg) loss and hepatitis B e antibody (anti-HBe) seroconversion in HBeAg-positive chronic hepatitis B and to sustain biochemical and virological remission in HBeAg-negative chronic hepatitis B. Currently, three drugs are licensed for chronic hepatitis B: interferon-alpha, lamivudine and adefovir dipivoxil. In patients with HBeAg-positive chronic hepatitis B, all of these drugs achieve HBeAg loss (24-33%) and anti-HBe seroconversion (12-30%) rates significantly superior to those observed in untreated placebo controls. In patients with HBeAg-negative chronic hepatitis B, the sustained off-therapy response rate is 20-25% after a > or =12-month course of interferon-alpha and minimal (<10%), if any, after a 12-month course of lamivudine or adefovir. Long-term lamivudine induces an initial response in 70-90% of patients, but only 30-40% of patients remain in remission after the third year due to progressively increasing viral resistance. Long-term adefovir achieves a response in approximately 70% of patients at 12 months, which is maintained at 24 months with rare (<2%) drug resistance. Adefovir is also effective against lamivudine-resistant strains. Many other anti-viral agents, immunomodulatory approaches and combination therapies are currently being evaluated in chronic hepatitis B.     

Adefovir dipivoxil in chronic hepatitis B infection

Adefovir dipivoxil, an acyclic nucleotide analogue, is effective for the treatment of chronic hepatitis B in both hepatitis B e antigen (HBeAg)-positive and -negative patients, with improvement in liver histology, hepatitis B virus (HBV) DNA levels, alanine aminotransferase levels, and HBeAg seroconversion (for HBeAg-positive patients). It is also effective against lamivudine-resistant strains of hepatitis B mutations. It has been studied in pre- and post-liver transplant patients. Compared to lamivudine, adefovir dipivoxil is associated with a much lower risk of emergence of drug-resistant HBV. Adefovir-associated resistant virus is susceptible to lamivudine therapy. The recommended dose of adefovir dipivoxil 10 mg is associated with low risk of nephrotoxicity. Adefovir dipivoxil can be recommended as a first-line treatment but can also be used in patients with chronic hepatitis B infection who are failing lamivudine therapy.     

Adefovir dipivoxil in chronic hepatitis B infection

Adefovir dipivoxil, an acyclic nucleotide analogue, is effective for the treatment of chronic hepatitis B in both hepatitis B e antigen (HBeAg)-positive and -negative patients, with improvement in liver histology, hepatitis B virus (HBV) DNA levels, alanine aminotransferase levels, and HBeAg seroconversion (for HBeAg-positive patients). It is also effective against lamivudine-resistant strains of hepatitis B mutations. It has been studied in pre- and post-liver transplant patients. Compared to lamivudine, adefovir dipivoxil is associated with a much lower risk of emergence of drug-resistant HBV. Adefovir-associated resistant virus is susceptible to lamivudine therapy. The recommended dose of adefovir dipivoxil 10 mg is associated with low risk of nephrotoxicity. Adefovir dipivoxil can be recommended as a first-line treatment but can also be used in patients with chronic hepatitis B infection who are failing lamivudine therapy.     

拉米夫定治疗慢性乙型肝炎及乙型肝炎病毒携带者的疗效评价

目的：观察拉米夫定对慢性乙型病毒性肝炎和病毒携带的疗效。方法：将92例病人分为治疗组50例，对照组42例，治疗组用拉米夫定100mg.d^-1。疗程52wk。治疗前后作肝功能。HBV－二对半HBV－DNA的测定。结果：治疗12wk时，治疗组与对照组ALT复常率的差异无的统计学意义（P＞0．05），但对于HBV－DNA阴转率，治疗组显高于对照组（P＜0．01）。治疗52wk时，治疗组ALT复常率和HBV－DNA阴转率分别为79．4％，74．0％，而对照组为46．9％和7．1％（P＜0．05），结论：拉米夫定能有效地抑制乙肝病毒的复制，是治疗慢性乙型肝炎的安全有效药物。