阿德福韦酯联合拉米夫定治疗拉米夫定耐药慢性乙型肝炎的临床观察

目的观察阿德福韦酯联合拉米夫定治疗拉米夫定耐药慢性乙型肝炎临床疗效。方法首先在充分告知符合研究对象的患者（80例）病情后根据患者的意愿选择分为：（1）对照组（单药治疗组，n=38例），在拉米夫定应用基础上重叠阿德福韦酯治疗12周后，停用拉米夫定，单独使用阿德福韦酯治疗132周；（2）观察组（联合治疗组，n=42例），出现拉米夫定耐药后联合应用阿德福韦酯144周。每3个月检测患者的HBV-DNA、HBV-M、肝功能、肾功能及血常规等。结果144周疗程结束后联合治疗组患者HBV—DNA转阴率明显优于对照组，疗效差异有统计学意义（P〈0．01），HbeAg在两组间未见明显差异（P〉0．05），联合治疗组治疗后肝功能复常率较单药治疗组高（P〈0．05）。结论阿德福韦酯联合拉米夫定治疗拉米夫定耐药慢性乙型肝炎有较好的疗效。

Effect of adefovir dipivoxfl combined with lamivudine in the treatment of patients with chronic hepatitis B resistant to lamivudine

Objective To observe the therapeutic efficacy of adefovir dipivoxil combined with lamivudine in the treatment of patients with chronic hepatitis B resistant to lamivudine. Methods Eighty patients with chronic hepatitis B resistant to lamivudine （YMDD mutantion）were divided into two groups according to their own willings. Group A（control group, n =38） and B（observation group, n=42）. Patients in group A were given adefovir dipivoxil 10 nag po per day for 132 weeks after a 12 weeks combined therapy of adefovir dipivoxil 10 mg each day and lamivudine 100 mg each day. Patients in group B were subjected to combined treatment of adefovir dipivoxil 10 mg per day with lami- vudine 100 mg per day for totally 144 weeks. Changes in serum HBV-DNA, HBV-M, liver functions, renal functions and blood routine test were dynamically monitored every 12 weeks. Results At the end of the 144 weeks of treat-ment,the rates of negative sero conversion for HBV-DNA were 95.2% in group B and 78. 9% in group A respectively. The rate of sera to turn negative for HBV-DNA in group B was significantly higher than that of patients in group A （ P 〈 0. 05 ）. The negative conversion rates of HBeAg showed no difference between two groups. The rate of liver func- tion normalization as well as other organ functions under testing in group B was showed significantly higher than that in group A. Conclusion Adefovir dipivoxfl combined with lamivudine in the treatment of the patients with chronic hepatitis B resistant to larnivudine has better therapeutic effects.