拉米夫定与阿德福韦酯联合治疗慢性乙型肝炎疗效观察

目的观察拉米夫定与阿德福韦酯联合治疗慢性乙型肝炎疗效。方法将该科2010年1月至2012年3月住院和门诊收治的100例慢性乙型肝炎患者分为联合组49例和单药组51例,两组患者均给予甘草酸二铵、还原性谷胱甘肽保肝治疗10-20 d。联合组患者抗乙型肝炎病毒（HBV）治疗采用拉米夫定100 mg和阿德福韦酯10 mg,每天1次;单药组患者采用阿德福韦酯10 mg,每天1次。所有患者在治疗前,治疗后12、24、48、96周抽血检测肝功能、肾功能、血常规;用化学发光法检测乙肝表面抗原、乙肝表面抗体、乙肝e抗原（HBeAg）、乙肝e抗体、乙肝核心抗体;用荧光定量聚合聚链反应检测HBV-DNA水平。观察比较两组患者丙氨酸氨基转移酶（ALT）复发率、HBV-DNA〈1×10^3copy/mL患者比例、HBeAg转阴率。结果治疗后12周,联合组患者ALT复常率、HBV-DNA〈1×10^3copy/mL患者比例、HBeAg转阴率分别为48.98%、55.10%、15.91%,单药组分别为15.69%、23.53%、4.54%,两组患者ALT复常率、HBV-DNA〈1×10^3copy/mL患者比例比较,差异有统计学意义（P〈0.05）;HBeAg转阴率比较,差异无统计学意义（P〉0.05）。治疗后24周,联合组患者ALT复常率、HBV-DNA〈1×10^3copy/mL患者比例、HBeAg转阴率分别为83.67%、85.71%、52.27%,单药组分别为43.14%、33.33%、15.91%,两组比较,差异均有统计学意义（P〈0.05）。治疗后48周,联合组患者ALT复发率、HBV-DNA〈1×10^3copy/mL患者比例、HBeAg转阴率分别为100.00%、97.96%、75.00%,单药组分别为60.78%、47.06%、27.27%,两组比较,差异均有统计学意义（P〈0.05）。治疗后96周,联合组的ALT复常率、HBV-DNA〈1×10^3copy/mL患者比例、HBeAg转阴率分别为100.00%、100.00%、81.82%,单药组分别为72.55%、56.86%、38.64%,两组比较,差异均有统计学意义（P〈0.05）。两组均未发现与抗病毒有关的明显不良反应。单药组治疗96周时出现5例病毒学突破。结论拉米夫定与?

Clinical observation of lamivudine combined with adefovir dipivoxil for chronic hepatitis B

Objective To observe the efficacy of lamivudine combined with adefovir dipivoxil in the treatment of patients with chronic hepatitis B（CHB）. Methods A total of 100 CHB patients,who were hospitalized and received in outpatient service from January to 2010 to March 2012,were divided into combination group（n=49） and monotherapy group（n=51）. Both groups received diammonium glycyrrhizinic and reduced glutathione for liver protection treatment for 10-20 d. The combination group was treated with 100 mg lamivudine and 10 mg adefovir dipivoxil once daily,while the monotherapy group was treated with 10 mg adefovir once daily. Liver function,renal function and blood routine examination of all the patients were detected on 12 th,24th,48thand96 thweek after the treatment;hepatitis B surface antigen（HBsAg）,hepatitis B surface antibody（HBsAb）,hepatitis B e antigen（HBeAg）,hepatitis B e antibody（HBeAb） and hepatitis B core antibody（HBcAb） were determined by chemiluminiscence;the HBV-DNA levels were detected by fluorogenic quantitative PCR. The normalization rate of ALT, proportion of HBV-DNA1×10^3copy/mL and negative conversion ratio of HBeAg between the two groups were observed. Results 12 weeks after treatment,the normalization rate,proportion of HBV-DNA〈 1 ×10^3copy/mL and negative conversion ratio of HBeAg in the combination group were 48.98%,55.10% and 15.91% respectively,which were 15.69%,23.53% and 4.54% respectively in the monotherapy group,and the differences between the two groups on normalization rate of ALT and proportion of HBV-DNA〈1×10^3copy/mL had statistical significance（P〈0.05）,but the difference on negative conversion ratio of HBeAg were not statistically significant（P〈0.05）;24weeks after treatment,the normalization rate,proportion of HBV-DNA〈1×10^3copy/mL and negative conversion ratio of HBeAg in the combination group were 83.67%,85.71% and 52.27% respectively,which were 43.14%,33.33% and 15.91% respectively in the monotherapy group,and the differences betwe