不同剂量阿德福韦酯停药后肝炎91例临床分析

目的探讨不同剂量ADV治疗CHB患者停药后肝炎复发率与停药原因。方法对635例不同剂量ADV治疗的CHB患者定期检测肝功能、HBVDNA并建立Excel随访系统，比较各组停药后肝炎发生率。结果半量组停药后肝炎发生率为14．2％，常量组停药后肝炎发生率为13．7％，1．5倍量组停药后肝炎发生率为12．5％，2倍量组停药后肝炎发生率为16．2％，联合治疗组停药后肝炎发生率为19-3％；各组累计停药肝炎91例（14.3％），停药相关肝癌2例（0．3％），重症肝炎3例（O．5％），死亡4例（0．6％）。结论停药主要原因为包括效果不满意46．1％、经济困难21．9％，抗病毒认知度不够13．1％。2倍量组与联合治疗组停药肝炎发生率均高于常量组，差异均无统计学意义（P均〉0．05）。加强健康教育与医患沟通，提高疾病认知度、定期检查并不断优化治疗是防止停药肝炎及相关事件的关键。

Clinical analysis of 91 cases with hepatitis B after discontinuation of different doses of ADV

Objective To explore the different dosages of ADV for the treatment of chronic hepatitis B （CHB） patients after drug withdrawal hepatitis incidence and reason for discontinuation. Methods Total of 635 cases of different dosages of ADV therapy in patients with CHB liver meritorious service is regular detection, HBV DNA and build Excel follow-up system, compare each withdrawal hepatitis incidence. Results Half a set of drug withdrawal hepatitis 14.2%, constant withdrawal hepatitis was 13.7%, 1.5-2 times the amount of drug withdrawal hepatitis group 12.5%-16.2%, united group of drug withdrawal hepatitis, 19.3%; Each group accumulative total withdrawal hepatitis, 91 eases （14.3%）, drug cessation related hepatocellular carcinoma 2 cases, 3 cases of severe hepatitis, 4 eases died. Conclusions Main reason for the discontinuation is effect is not satisfied with 46.1% and 21.9% economic difficulties, 13.1% antiviral awareness is not enough. The drug withdrawal hepatitis incidence of 2 times the amount group and combined treatment group was higher than constants group but no statistical difference. Obviously strengthen health education and doctor-patient communication, improve disease awareness, regular check and optimize treatment is the key to prevent withdrawal hepatitis and the related events.